Provider Demographics
NPI:1376254284
Name:GOLLIHER, JENNA LYNN (COTA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:GOLLIHER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 FREDRICK CT APT 8
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-3414
Mailing Address - Country:US
Mailing Address - Phone:920-639-2414
Mailing Address - Fax:
Practice Address - Street 1:1207 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3037
Practice Address - Country:US
Practice Address - Phone:920-593-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant