Provider Demographics
NPI:1881130110
Name:HUGHES, JENNA (OTRL)
Entity type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10141 SKANEATELES TPKE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13314-1604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3128 BOXELDER DR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5808
Practice Address - Country:US
Practice Address - Phone:307-634-7901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1233225X00000X
CO0004889225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist