Provider Demographics
NPI:1740892892
Name:ELMORE, JENNA (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:ELMORE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 OLD DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT STEPHENS
Mailing Address - State:AL
Mailing Address - Zip Code:36569-6716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14600 SAINT STEPHENS AVE
Practice Address - Street 2:
Practice Address - City:CHATOM
Practice Address - State:AL
Practice Address - Zip Code:36518-6711
Practice Address - Country:US
Practice Address - Phone:251-847-4294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5222225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist