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General NPI Number Information
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NPI Number | 1376394155
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Entity Type | Individual
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Provider Name | JENNIFER TERESE JANECZKO COTA/L
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Gender | Female
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Dates
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Enumeration Date | 03/29/2024
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 800 BLOSSOM HILL RD
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City | LOS GATOS
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State | CA
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Zip | 95032-3562
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Country | US
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Telephone | 408-357-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 16742 VICKY LN
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City | ORLAND HILLS
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State | IL
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Zip | 60487-6035
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Country | US
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Telephone |
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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 | OTA5784
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License Number State | CA
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