Provider Demographics
NPI:1275700916
Name:OLENWINE, JENNIFER SMITH (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SMITH
Last Name:OLENWINE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4726 W MONCRIEFF PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-1604
Mailing Address - Country:US
Mailing Address - Phone:720-855-1023
Mailing Address - Fax:720-855-1024
Practice Address - Street 1:4726 W MONCRIEFF PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-1604
Practice Address - Country:US
Practice Address - Phone:720-855-1023
Practice Address - Fax:720-855-1024
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1024912225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03225372Medicaid