Provider Demographics
NPI:1760670434
Name:PELKEY, JENNIFER KAYE (COTA)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:KAYE
Last Name:PELKEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 S AVE B
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4350
Mailing Address - Country:US
Mailing Address - Phone:269-487-8177
Mailing Address - Fax:
Practice Address - Street 1:2222 S AVE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8315
Practice Address - Country:US
Practice Address - Phone:928-783-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3710224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ224Z00000XOtherTAXONOMY CODE