Provider Demographics
NPI:1821699729
Name:WEISINGER, JENNA ROSE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ROSE
Last Name:WEISINGER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 EUSTACE DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5331
Mailing Address - Country:US
Mailing Address - Phone:631-871-9091
Mailing Address - Fax:
Practice Address - Street 1:395 SUNKEN MEADOW RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-1000
Practice Address - Country:US
Practice Address - Phone:631-269-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist