Provider Demographics
NPI:1730324088
Name:JENNINGS, KARYNNA EMMA (OTR/L)
Entity Type:Individual
Prefix:
First Name:KARYNNA
Middle Name:EMMA
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6342 SW 164TH PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-4478
Mailing Address - Country:US
Mailing Address - Phone:305-505-2868
Mailing Address - Fax:305-228-6251
Practice Address - Street 1:3860 SW 137TH AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175
Practice Address - Country:US
Practice Address - Phone:305-228-6252
Practice Address - Fax:305-228-6251
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTT13331225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000709300Medicaid