Healthcare Provider Details

I. General information

NPI: 1790612133
Provider Name (Legal Business Name): JENNA PRESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 MAIN ST
PERRY GA
31069-3353
US

IV. Provider business mailing address

1013 MAIN ST
PERRY GA
31069-3353
US

V. Phone/Fax

Practice location:
  • Phone: 478-224-1440
  • Fax:
Mailing address:
  • Phone: 478-224-1440
  • Fax:

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: