Provider Demographics
NPI:1205063351
Name:KORNOFF, JENNIFER MICHELLE (MS OT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:KORNOFF
Suffix:
Gender:F
Credentials:MS OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6991 BALBOA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3447
Mailing Address - Country:US
Mailing Address - Phone:858-496-8232
Mailing Address - Fax:
Practice Address - Street 1:6991 BALBOA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3447
Practice Address - Country:US
Practice Address - Phone:858-496-8232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11901225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist