Jenna Ann Mandernach, OTRL

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5201013758 Issued in MI

Practice address

8175 Movie Dr
Brighton, MI 48116-7444

Phone

(248) 277-3005

NPI assigned

Feb 1, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• BWC Brighton LLC

  dba Blossom Children's Center-Brighton

  • Community/Behavioral Health Agency
  • Brighton, MI
  • NPI 1104585421
  NPD
• BWC Brighton LLC

  dba Blossom Children's Center-Brighton

  • Speech-Language Pathologist
  • Brighton, MI
  • NPI 1366282980
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742515200000",
    "number": "1235992272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8175 MOVIE DR",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481167444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8175 MOVIE DR",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481167444",
            "telephone_number": "248-277-3005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDERNACH",
        "first_name": "JENNA",
        "middle_name": "ANN",
        "credential": "OTRL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-01",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201013758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matt Jay Malec, CTRS
• Jaclyn Beth Malek, MA LLPC
• Kathy Malone, LBSW, RN, IBCLC
• Robert Manchester, CPHT
• Heather Mancina, MS, BCBA, LBA
• Emily Jane Mandziuk
• Rommark Baltazar Manlimos, LMFT
• Mitchell Mann, M.D.
• Catharine Manzo, LMSW, CAC-1
• Patricia Sue Marcozzi, RN

• Occupational Therapist in Brighton, MI
• Providers in Brighton, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.