Provider Demographics
NPI:1982848479
Name:THOMAS, JENNIFER HERYNK (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HERYNK
Last Name:THOMAS
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 1:5820 W 85TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-1665
Mailing Address - Country:US
Mailing Address - Phone:415-425-3970
Mailing Address - Fax:
Practice Address - Street 1:5820 W 85TH TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-1665
Practice Address - Country:US
Practice Address - Phone:415-425-3970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4855225XP0200X
KS17-02798225XP0200X
MO2013007248174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No174400000XOther Service ProvidersSpecialist