Provider Demographics
NPI:1740465921
Name:SANTORO, MARY JENNIFER (OTR, ATP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JENNIFER
Last Name:SANTORO
Suffix:
Gender:F
Credentials:OTR, ATP
Other - Prefix:MRS
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:SANTORO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR, ATP
Mailing Address - Street 1:1203 CROSSBOW DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-1937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1203 CROSSBOW DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-1937
Practice Address - Country:US
Practice Address - Phone:225-273-5574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X, 225XE1200X, 225XH1300X, 225XN1300X
LAZ10798225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman Factors
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation