Provider Demographics
NPI:1932578390
Name:CUNNINGHAM, JENNIFER LEE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:382 BLACKBROOK RD
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1294
Mailing Address - Country:US
Mailing Address - Phone:440-487-2071
Mailing Address - Fax:
Practice Address - Street 1:10949 JOHNNYCAKE RIDGE RD
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-2430
Practice Address - Country:US
Practice Address - Phone:440-354-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.06059224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant