Provider Demographics
NPI:1295016251
Name:EPKEY, JENNA (MS, OTRL)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:EPKEY
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:BASTIANELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTRL
Mailing Address - Street 1:2111 MERRITT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2111 MERRITT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6916
Practice Address - Country:US
Practice Address - Phone:517-332-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008045225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist