Healthcare Provider Details

I. General information

NPI: 1740807635
Provider Name (Legal Business Name): JENNA JEAN SEMRAU OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA JEAN SCHYMA

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2653 COUNTY ROAD 74
SAINT CLOUD MN
56301-2205
US

IV. Provider business mailing address

10635 RAVEN LOOP
FOLEY MN
56329-9008
US

V. Phone/Fax

Practice location:
  • Phone: 320-291-3451
  • Fax:
Mailing address:
  • Phone: 320-291-3451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number106261
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: