Healthcare Provider Details

I. General information

NPI: 1205916012
Provider Name (Legal Business Name): JENNIFER L BRASPENNING OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER KRATZ

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 JOURNEY WAY
VALPARAISO IN
46383-0078
US

IV. Provider business mailing address

88 E 600 S
VALPARAISO IN
46383-9608
US

V. Phone/Fax

Practice location:
  • Phone: 192-554-3782
  • Fax:
Mailing address:
  • Phone: 219-308-0881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31003276A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: