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General NPI Number Information
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NPI Number | 1669689030
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Entity Type | Individual
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Provider Name | JENNIFER LYNN WHEATON OTR, CHT, CLT
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 5315 ELLIOTT DR STE 202B
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City | YPSILANTI
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State | MI
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Zip | 48197-8634
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Country | US
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Telephone | 734-712-5820
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Fax | 734-712-5818
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Provider Business Mailing Address
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Address Line | 7903 LAUREL ST
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City | BRIGHTON
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State | MI
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Zip | 48116-1329
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Country | US
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Telephone | 810-429-2281
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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 | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | 5201000275
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License Number State | MI
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