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General NPI Number Information
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NPI Number | 1780491571
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Entity Type | Individual
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Provider Name | JENNIFER ENNS
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Gender | Female
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 623 COMMERCIAL ST
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City | EMPORIA
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State | KS
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Zip | 66801-3901
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Country | US
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Telephone | 620-803-2855
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Fax | 620-208-4488
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Provider Business Mailing Address
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Address Line | 505 WILSON ST
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City | EMPORIA
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State | KS
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Zip | 66801
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Country | US
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Telephone | 620-660-7009
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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 | 18-01977
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License Number State | KS
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