Provider Demographics
NPI:1679271555
Name:BOTCHICK, JENNIFER L (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BOTCHICK
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:GRECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:12419 PAINESVILLE WARREN RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9213
Mailing Address - Country:US
Mailing Address - Phone:440-479-1819
Mailing Address - Fax:
Practice Address - Street 1:12419 PAINESVILLE WARREN RD
Practice Address - Street 2:
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9213
Practice Address - Country:US
Practice Address - Phone:440-479-1819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist