Provider Demographics
NPI:1619641545
Name:REINE-BASKETT, JENNY MICHELLE (COTA)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:MICHELLE
Last Name:REINE-BASKETT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 CHAPTICO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-1406
Mailing Address - Country:US
Mailing Address - Phone:304-550-3697
Mailing Address - Fax:
Practice Address - Street 1:200 HAMPTON WOOD RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NC
Practice Address - Zip Code:27845
Practice Address - Country:US
Practice Address - Phone:252-534-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002518224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant