Provider Demographics
NPI:1437659109
Name:MOTT, JENNA KATHLEEN (OTRL)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:KATHLEEN
Last Name:MOTT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:KATHLEEN
Other - Last Name:HASSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1017 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1585
Mailing Address - Country:US
Mailing Address - Phone:810-623-7528
Mailing Address - Fax:
Practice Address - Street 1:7566 N PINEFIELD DR
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-9379
Practice Address - Country:US
Practice Address - Phone:734-474-2905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010022225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist