Provider Demographics
NPI:1952573933
Name:WEISSEND, JENNIE LEIGH (OT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:LEIGH
Last Name:WEISSEND
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:JENNIE
Other - Middle Name:LEIGH
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:7540 N 19TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7967
Mailing Address - Country:US
Mailing Address - Phone:888-873-4221
Mailing Address - Fax:888-543-2289
Practice Address - Street 1:701 MONROE ST NW
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1358
Practice Address - Country:US
Practice Address - Phone:256-332-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2177225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist