Provider Demographics
NPI:1184748253
Name:ATWOOD, JENNIFER MARIE-BRDA (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE-BRDA
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:BRDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:29267 COMMONWEALTH ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-2067
Mailing Address - Country:US
Mailing Address - Phone:586-552-8164
Mailing Address - Fax:
Practice Address - Street 1:320 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2125
Practice Address - Country:US
Practice Address - Phone:586-226-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
MI520200683224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant