Provider Demographics
NPI:1760658199
Name:ANNUNZIATA, JENNIFER LYN (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYN
Last Name:ANNUNZIATA
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OCCUPATIONAL THERAPI
Mailing Address - Street 1:14130 23RD AVENUE NORTH
Mailing Address - Street 2:THERAPY JUNCTION
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447
Mailing Address - Country:US
Mailing Address - Phone:763-383-7666
Mailing Address - Fax:763-383-6013
Practice Address - Street 1:14130 23RD AVENUE NORTH
Practice Address - Street 2:THERAPY JUNCTION
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447
Practice Address - Country:US
Practice Address - Phone:763-383-7666
Practice Address - Fax:763-383-6016
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103567225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist