Provider Demographics
NPI:1740402619
Name:WILLIAMSON, JENNA L (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:L
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 NORTH SULLIVAN ROAD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46538
Mailing Address - Country:US
Mailing Address - Phone:574-834-2923
Mailing Address - Fax:
Practice Address - Street 1:900 PROVIDENT DRIVE
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580
Practice Address - Country:US
Practice Address - Phone:573-371-2500
Practice Address - Fax:574-371-2779
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003209A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist