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General NPI Number Information
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NPI Number | 1407197163
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Entity Type | Individual
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Provider Name | KELLY D JENKINS O.T.
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Gender | Female
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 05/02/2013
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Provider Practice Location Address
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Address Line | 5334 MEADOW LANE CT
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City | SHEFFIELD VILLAGE
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State | OH
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Zip | 44035-1469
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Country | US
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Telephone | 440-934-8987
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Fax |
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Provider Business Mailing Address
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Address Line | 5334 MEADOW LANE CT
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City | SHEFFIELD VILLAGE
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State | OH
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Zip | 44035-1469
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Country | US
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Telephone | 440-934-8987
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT.007456
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License Number State | OH
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