Provider Demographics
NPI:1942608823
Name:HERRMANN, JENNIFER (OTD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24066
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66283-4066
Mailing Address - Country:US
Mailing Address - Phone:515-689-0854
Mailing Address - Fax:
Practice Address - Street 1:700 MONTEREY PL
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2266
Practice Address - Country:US
Practice Address - Phone:620-694-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03025225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist