Provider Demographics
NPI:1831438134
Name:STOUSE, JENNA L (MS, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:L
Last Name:STOUSE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:L
Other - Last Name:MAXEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10483 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-9311
Mailing Address - Country:US
Mailing Address - Phone:810-771-7686
Mailing Address - Fax:810-771-7685
Practice Address - Street 1:1030 W HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8701
Practice Address - Country:US
Practice Address - Phone:517-546-9000
Practice Address - Fax:517-546-9006
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007681225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist