Provider Demographics
NPI:1669900049
Name:MINNIS, JENNIFER J (MOTR/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:MINNIS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7135 NW EDGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-2433
Mailing Address - Country:US
Mailing Address - Phone:785-393-3694
Mailing Address - Fax:
Practice Address - Street 1:998 PLATTE FALLS RD
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-7330
Practice Address - Country:US
Practice Address - Phone:816-858-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03143225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist