Provider Demographics
NPI:1427209121
Name:KOZEMKO, JENNIFER ANNE (OTR/L, CLT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANNE
Last Name:KOZEMKO
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:NESBITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:37 N CHEMUNG ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NY
Mailing Address - Zip Code:14892-1211
Mailing Address - Country:US
Mailing Address - Phone:607-565-6298
Mailing Address - Fax:607-565-6261
Practice Address - Street 1:37 N CHEMUNG ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NY
Practice Address - Zip Code:14892-1211
Practice Address - Country:US
Practice Address - Phone:607-565-6298
Practice Address - Fax:607-565-6261
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007715L225X00000X
NY016393225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist