Provider Demographics
NPI:1801218367
Name:NIESNER, JENNA KETTLER (OTR)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:KETTLER
Last Name:NIESNER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LEIGH
Other - Last Name:KETTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:9220 KIRBY DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2533
Mailing Address - Country:US
Mailing Address - Phone:713-383-9700
Mailing Address - Fax:
Practice Address - Street 1:9220 KIRBY DR
Practice Address - Street 2:SUITE 1000
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2533
Practice Address - Country:US
Practice Address - Phone:713-383-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115661225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist