Provider Demographics
NPI:1801192943
Name:CRANE, JENNIFER ELIZABETH (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:CRANE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 ABETO ST NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5905
Mailing Address - Country:US
Mailing Address - Phone:321-427-2608
Mailing Address - Fax:
Practice Address - Street 1:978 ABETO ST NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5905
Practice Address - Country:US
Practice Address - Phone:321-427-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10861224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant