Provider Demographics
NPI:1356771893
Name:BLYTHE, JENNIFER PAULINE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:PAULINE
Last Name:BLYTHE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:PAULINE
Other - Last Name:WINEBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1323 TAYLOR ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011
Mailing Address - Country:US
Mailing Address - Phone:202-413-5446
Mailing Address - Fax:
Practice Address - Street 1:935 TRANCAS ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2932
Practice Address - Country:US
Practice Address - Phone:415-823-3498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13250225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist