Healthcare Provider Details

I. General information

NPI: 1235395252
Provider Name (Legal Business Name): JENNIFER RENEE ALLEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SE 168TH AVE APT 91
VANCOUVER WA
98684-8431
US

IV. Provider business mailing address

620 SE 168TH AVE APT 91
VANCOUVER WA
98684-8431
US

V. Phone/Fax

Practice location:
  • Phone: 503-781-4462
  • Fax:
Mailing address:
  • Phone: 503-781-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number00004145
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number1005244
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number00004145
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: