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General NPI Number Information
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NPI Number | 1588867329
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Entity Type | Individual
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Provider Name | JENNY S MARK OT
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Gender | Female
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 253 W SIXTH ST
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City | MINSTER
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State | OH
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Zip | 45865
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Country | US
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Telephone | 419-501-2165
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Fax | 419-501-2166
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Provider Business Mailing Address
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Address Line | 4555 DAWSON RD
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City | HOUSTON
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State | OH
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Zip | 45333-9635
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Country | US
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Telephone | 937-498-1863
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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 | OT006719
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License Number State | OH
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