Provider Demographics
NPI:1780222554
Name:SARNOWSKI, JENNIA
Entity Type:Individual
Prefix:
First Name:JENNIA
Middle Name:
Last Name:SARNOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PINE CONE DR STE 104A
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8683
Mailing Address - Country:US
Mailing Address - Phone:386-283-8316
Mailing Address - Fax:
Practice Address - Street 1:9 PINE CONE DR STE 104A
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8683
Practice Address - Country:US
Practice Address - Phone:386-283-8316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17123225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist