Healthcare Provider Details

I. General information

NPI: 1588010946
Provider Name (Legal Business Name): JENNIFER GRACE O'HANLON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 E 101ST ST
CLEVELAND OH
44106-4110
US

IV. Provider business mailing address

1909 E 101ST ST
CLEVELAND OH
44106-4110
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-8118
  • Fax: 216-472-4525
Mailing address:
  • Phone: 216-791-8118
  • Fax: 216-472-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT17680
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: