Provider Demographics
NPI:1518298512
Name:SOMMER, JENNIFER RENEE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RENEE
Last Name:SOMMER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:RENEE
Other - Last Name:LOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:712 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:IN
Mailing Address - Zip Code:47137-2264
Mailing Address - Country:US
Mailing Address - Phone:812-739-2292
Mailing Address - Fax:812-739-4756
Practice Address - Street 1:712 W 2ND ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:IN
Practice Address - Zip Code:47137-2264
Practice Address - Country:US
Practice Address - Phone:812-739-2292
Practice Address - Fax:812-739-4756
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001520A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant