Provider Demographics
NPI:1407084650
Name:HENNING, JANE M (OT/L)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:HENNING
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 CANANDAIGUA RD
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-9342
Mailing Address - Country:US
Mailing Address - Phone:585-737-1726
Mailing Address - Fax:
Practice Address - Street 1:1726 CANANDAIGUA RD
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-9342
Practice Address - Country:US
Practice Address - Phone:585-737-1726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0003916-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist