Provider Demographics
NPI:1619386539
Name:ROCK, JENNIFER (OT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:ROCK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MANDELBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:44 MARITIME DRIVE
Mailing Address - Street 2:PENDLETON HEALTH AND REHAB CENTER
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355
Mailing Address - Country:US
Mailing Address - Phone:860-572-1700
Mailing Address - Fax:860-572-4270
Practice Address - Street 1:44 MARITIME DRIVE
Practice Address - Street 2:PENDLETON HEALTH AND REHAB CENTER
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355
Practice Address - Country:US
Practice Address - Phone:860-572-1700
Practice Address - Fax:860-572-4270
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001745225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist