Provider Demographics
NPI:1770478117
Name:HARE, JENNA (MPH, OTD, ORT/L)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:HARE
Suffix:
Gender:F
Credentials:MPH, OTD, ORT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18415 BELOTE LN
Mailing Address - Street 2:
Mailing Address - City:ONANCOCK
Mailing Address - State:VA
Mailing Address - Zip Code:23417-2896
Mailing Address - Country:US
Mailing Address - Phone:757-678-2661
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 149
Practice Address - Street 2:
Practice Address - City:BELLE HAVEN
Practice Address - State:VA
Practice Address - Zip Code:23306-0149
Practice Address - Country:US
Practice Address - Phone:757-442-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119010962225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist