Provider Demographics
NPI:1457520504
Name:MIKONCZY, JENNIFER M (OT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MIKONCZY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 GRAFF CT
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1640
Mailing Address - Country:US
Mailing Address - Phone:810-953-3256
Mailing Address - Fax:
Practice Address - Street 1:412 GRAFF CT
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1640
Practice Address - Country:US
Practice Address - Phone:810-953-3256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy