Provider Demographics
NPI:1891262630
Name:ELDRIDGE, JENNA LEIGH (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEIGH
Last Name:ELDRIDGE
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 1:728 FRANKLIN AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4700
Mailing Address - Country:US
Mailing Address - Phone:732-865-2088
Mailing Address - Fax:
Practice Address - Street 1:805 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5924
Practice Address - Country:US
Practice Address - Phone:646-315-1548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022630225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist