Provider Demographics
NPI:1528180270
Name:STAMM, JENNIFER PAULINE (OTR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PAULINE
Last Name:STAMM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-9264
Mailing Address - Country:US
Mailing Address - Phone:262-670-9501
Mailing Address - Fax:262-670-6960
Practice Address - Street 1:N9368 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-9676
Practice Address - Country:US
Practice Address - Phone:262-227-9569
Practice Address - Fax:262-670-6960
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3362-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist