Healthcare Provider Details

I. General information

NPI: 1760305452
Provider Name (Legal Business Name): KATHERINE JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 S LUDLOW ST
DAYTON OH
45402-1813
US

IV. Provider business mailing address

1267 CHANNINGWAY DR APT G
FAIRBORN OH
45324-8714
US

V. Phone/Fax

Practice location:
  • Phone: 937-542-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT013802
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: