Healthcare Provider Details

I. General information

NPI: 1538815469
Provider Name (Legal Business Name): JENNA DE GUZMAN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6270 N GOVERNMENT WAY
DALTON GARDENS ID
83815-9214
US

IV. Provider business mailing address

1902 E 63RD AVE
SPOKANE WA
99223-8403
US

V. Phone/Fax

Practice location:
  • Phone: 208-666-0611
  • Fax:
Mailing address:
  • Phone: 208-661-9844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0T2531
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: