Healthcare Provider Details

I. General information

NPI: 1831686138
Provider Name (Legal Business Name): JENNA MARIE FLEMING MOT, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S CLINTON ST
FORT WAYNE IN
46802-3594
US

IV. Provider business mailing address

1200 S CLINTON ST
FORT WAYNE IN
46802-3594
US

V. Phone/Fax

Practice location:
  • Phone: 260-467-1000
  • Fax:
Mailing address:
  • Phone: 260-467-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31006592A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT013548
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: