Provider Demographics
NPI:1346855111
Name:JENNINGS, JENNA BROOKE (OTR, MOT)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:BROOKE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:OTR, MOT
Other - Prefix:MISS
Other - First Name:JENA
Other - Middle Name:BROOKE
Other - Last Name:LIGHTFOOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 STONEGLEN DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-1316
Mailing Address - Country:US
Mailing Address - Phone:817-734-6515
Mailing Address - Fax:817-717-8584
Practice Address - Street 1:630 STONEGLEN DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-1316
Practice Address - Country:US
Practice Address - Phone:817-734-6515
Practice Address - Fax:817-717-8584
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121161225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist