Provider Demographics
NPI:1659872174
Name:O'CONNOR, JENNIFER MARIE (MPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:OVIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BEAUMONT MEDICAL CENTER WEST BLOOMFIELD
Mailing Address - Street 2:6900 ORCHARD LAKE RD., SUITE LL09
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-855-7411
Mailing Address - Fax:248-855-7419
Practice Address - Street 1:BEAUMONT MEDICAL CENTER WEST BLOOMFIELD
Practice Address - Street 2:6900 ORCHARD LAKE RD., SUITE LL09
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-855-7411
Practice Address - Fax:248-855-7419
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist