Healthcare Provider Details

I. General information

NPI: 1891997227
Provider Name (Legal Business Name): JENNIFER HENSHAW-LEFEVER PA, O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 MONTGOMERY DR
SANTA ROSA CA
95405-4557
US

IV. Provider business mailing address

1405 MONTGOMERY DR
SANTA ROSA CA
95405-4557
US

V. Phone/Fax

Practice location:
  • Phone: 707-546-1922
  • Fax: 707-546-1897
Mailing address:
  • Phone: 707-546-1922
  • Fax: 707-546-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2068
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: