Provider Demographics
NPI:1366638322
Name:BURY, JENNY (OTR)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:BURY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:ALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W7842 AIRPORT RD APT EAST
Mailing Address - Street 2:
Mailing Address - City:CRIVITZ
Mailing Address - State:WI
Mailing Address - Zip Code:54114-7455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2121 S ONEIDA ST STE A
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4617
Practice Address - Country:US
Practice Address - Phone:920-209-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-23
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4125225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist