Healthcare Provider Details

I. General information

NPI: 1679299713
Provider Name (Legal Business Name): JENNA ROOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 BROCK DR
LOOKOUT MOUNTAIN GA
30750-2207
US

IV. Provider business mailing address

1690 ROSE MOSS CT SE
SMYRNA GA
30082-3969
US

V. Phone/Fax

Practice location:
  • Phone: 301-275-4057
  • Fax: 423-702-4493
Mailing address:
  • Phone: 301-275-4057
  • Fax: 423-702-4493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: