Healthcare Provider Details

I. General information

NPI: 1487955910
Provider Name (Legal Business Name): JENNIFER LEE FONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 CASS ELIZABETH RD
WATERFORD MI
48327-3106
US

IV. Provider business mailing address

501 N CASS LAKE RD
WATERFORD MI
48328-2307
US

V. Phone/Fax

Practice location:
  • Phone: 248-682-2620
  • Fax:
Mailing address:
  • Phone: 248-682-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201004571
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: