Provider Demographics
NPI:1881777431
Name:RODNEY, JENNIFER (CTRS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RODNEY
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1519
Mailing Address - Country:US
Mailing Address - Phone:207-989-2034
Mailing Address - Fax:207-989-5971
Practice Address - Street 1:11 LIME ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3410
Practice Address - Country:US
Practice Address - Phone:207-596-7555
Practice Address - Fax:207-596-6565
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME51548225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist