MEDICARE: JENNA ROOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1679299713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA ROOY

Provider Business Mailing Address
First Line	:	1690 ROSE MOSS CT SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-3969
Country	:	US
Telephone Number	:	301-275-4057
Fax Number	:	423-702-4493

Provider Business Practice Location Address
First Line	:	37 BROCK DR
Second Line	:
City	:	LOOKOUT MOUNTAIN
State	:	GA
Zip	:	30750-2207
Country	:	US
Telephone Number	:	301-275-4057
Fax Number	:	423-702-4493

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	10/19/2022

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Directions to “ JENNA ROOY ” Practice Location

Language	Start Address	Practice Location

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