Provider Demographics
NPI:1356606107
Name:THOMAS, JENNA M (OTR)
Entity type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 APRIL WIND DR E
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5935
Mailing Address - Country:US
Mailing Address - Phone:936-662-7847
Mailing Address - Fax:
Practice Address - Street 1:4840 W PANTHER CREEK DR STE 206
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3542
Practice Address - Country:US
Practice Address - Phone:281-681-3020
Practice Address - Fax:281-298-9905
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114839225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist