Provider Demographics
NPI:1679229157
Name:PETERMAN, JENNIFER HELEN (COTA/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HELEN
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32883 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1466
Mailing Address - Country:US
Mailing Address - Phone:217-690-7565
Mailing Address - Fax:
Practice Address - Street 1:37900 CHESTER RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1044
Practice Address - Country:US
Practice Address - Phone:440-695-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA007497224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty