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General NPI Number Information
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NPI Number | 1790992642
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Entity Type | Individual
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Provider Name | JENNIFER S FRIESL OTRL
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Gender | Female
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 802 E US HIGHWAY 20
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-7424
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Country | US
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Telephone | 219-872-7251
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Fax |
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Provider Business Mailing Address
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Address Line | 7684 RAILYARD DR SW
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City | BYRON CENTER
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State | MI
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Zip | 49315-9526
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Country | US
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Telephone | 219-477-0563
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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 | 31002184A
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License Number State | IN
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