Provider Demographics
NPI:1689107997
Name:DOWD, JENNIFER (OTRL)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DOWD
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S JEFFERY AVE
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:MI
Mailing Address - Zip Code:48847-1730
Mailing Address - Country:US
Mailing Address - Phone:989-280-1139
Mailing Address - Fax:
Practice Address - Street 1:501 S MISSION ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2869
Practice Address - Country:US
Practice Address - Phone:989-772-6785
Practice Address - Fax:989-772-1181
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009830225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist