Provider Demographics
NPI:1831413582
Name:HANKS, JENNY LYNN (OTR)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:HANKS
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 1:201 LAMKIN ST STE 101B
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3476
Mailing Address - Country:US
Mailing Address - Phone:171-925-3772
Mailing Address - Fax:171-925-3772
Practice Address - Street 1:201 LAMKIN ST STE 101B
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3476
Practice Address - Country:US
Practice Address - Phone:171-925-3772
Practice Address - Fax:171-925-3772
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1965225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist