Provider Demographics
NPI:1023586740
Name:STEWART, JENNA MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:ROTENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:3780 COPPERFIELD DR APT 1312
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5893
Mailing Address - Country:US
Mailing Address - Phone:602-628-3892
Mailing Address - Fax:
Practice Address - Street 1:2700 EARL RUDDER FWY S STE 1200
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-2810
Practice Address - Country:US
Practice Address - Phone:979-307-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant