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General NPI Number Information
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NPI Number | 1205606886
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Entity Type | Individual
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Provider Name | JENNIFER HENNESSEE COTA/L
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Gender | Female
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Dates
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Enumeration Date | 01/04/2024
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 1061 S SUN DR STE 1089
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City | LAKE MARY
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State | FL
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Zip | 32746-6169
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Country | US
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Telephone | 407-761-1905
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Fax |
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Provider Business Mailing Address
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Address Line | 330 SPRING LAKE HILLS DR
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-3427
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Country | US
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Telephone | 407-761-1905
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 13325
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License Number State | FL
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