Provider Demographics
NPI:1952439077
Name:BRENNAN, JENNIFER L (MS, OTR)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 HOPE RD
Mailing Address - Street 2:BLDG 5B, 1ST FLOOR
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1277
Mailing Address - Country:US
Mailing Address - Phone:732-380-7287
Mailing Address - Fax:732-380-7289
Practice Address - Street 1:615 HOPE RD
Practice Address - Street 2:BLDG 5B, 1ST FLOOR
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1277
Practice Address - Country:US
Practice Address - Phone:732-380-7287
Practice Address - Fax:732-380-7289
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00174300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26-2416034OtherTAX IDENTIFICATION NUMBER