Provider Demographics
NPI:1700089976
Name:CONKLIN, JENNIFER LYN (OTR)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LYN
Last Name:CONKLIN
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 1:527 TREESIDE DR
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1111
Mailing Address - Country:US
Mailing Address - Phone:330-928-0219
Mailing Address - Fax:
Practice Address - Street 1:2400 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9414
Practice Address - Country:US
Practice Address - Phone:330-483-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006211225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist