Provider Demographics
NPI:1598031098
Name:GRODEK, JENNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:GRODEK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 VALLEY LANE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-2301
Mailing Address - Country:US
Mailing Address - Phone:440-724-8552
Mailing Address - Fax:
Practice Address - Street 1:3048 VALLEY LANE DR
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-2301
Practice Address - Country:US
Practice Address - Phone:440-724-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.007987225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist