Provider Demographics
NPI:1831430578
Name:WELLENSTEIN, JENNIFER MARIE (OTR)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:WELLENSTEIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:DURFEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:161 GAGE RD
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-3426
Mailing Address - Country:US
Mailing Address - Phone:315-868-2897
Mailing Address - Fax:
Practice Address - Street 1:1 TERRACE HTS
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:NY
Practice Address - Zip Code:13411
Practice Address - Country:US
Practice Address - Phone:607-847-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020672-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist