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General NPI Number Information
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NPI Number | 1437450046
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Entity Type | Individual
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Provider Name | JENNIFER L REWA OT
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Gender | Female
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Dates
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Enumeration Date | 11/12/2010
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Last Update Date | 11/12/2010
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Provider Practice Location Address
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Address Line | 5831 128TH AVE
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City | FENNVILLE
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State | MI
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Zip | 49408-8415
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Country | US
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Telephone | 269-561-6540
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Fax | 269-561-6540
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Provider Business Mailing Address
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Address Line | 5831 128TH AVE
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City | FENNVILLE
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State | MI
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Zip | 49408-8415
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Country | US
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Telephone | 269-561-6540
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Fax | 269-561-6540
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | L1562393
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License Number State | MI
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