Provider Demographics
NPI:1871836288
Name:ALEXANDER, JENNA E (MSOTR)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:E
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MSOTR
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:E
Other - Last Name:ALCORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTR/L
Mailing Address - Street 1:13 WATER ST
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:PA
Mailing Address - Zip Code:16124-3029
Mailing Address - Country:US
Mailing Address - Phone:724-699-7706
Mailing Address - Fax:
Practice Address - Street 1:28100 TORCH PKWY
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3938
Practice Address - Country:US
Practice Address - Phone:630-413-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012317225X00000X, 225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology