Provider Demographics
NPI:1609099290
Name:MANNING, JENNIFER MICHELLE (OTR/L, CHT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:MANNING
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-0160
Mailing Address - Country:US
Mailing Address - Phone:505-368-7089
Mailing Address - Fax:505-368-7091
Practice Address - Street 1:HWY 491 NORTH
Practice Address - Street 2:NORTHERN NAVAJO MEDICAL CENTER
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-7089
Practice Address - Fax:505-368-7091
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103032225X00000X
MN201311087225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN909430000Medicaid
MN909430000Medicaid