Provider Demographics
NPI:1801190202
Name:PLATNICK, JENNIFER (OT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PLATNICK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 DIAMOND DR
Mailing Address - Street 2:APT 2903
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-3012
Mailing Address - Country:US
Mailing Address - Phone:518-852-8292
Mailing Address - Fax:
Practice Address - Street 1:1000 DIAMOND DR
Practice Address - Street 2:APT 2903
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3012
Practice Address - Country:US
Practice Address - Phone:518-852-8292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63013861225X00000X
TX11395225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist