Breauanna Nina Jennings, COTA
Individual provider Active NPI Occupational Therapy Assistant · Hammond, WI
NPI 1770009367 · NPPES record last updated Aug 16, 2017
Key facts
- NPI
- 1770009367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 5409 (WI)
- Practice address
- 425 Davis St
Hammond, WI 54015-9615 - Phone
- (715) 796-2218
- NPI assigned
- Aug 16, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5409 | WI | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 5409 | WI | Yes |
Addresses
Primary practice location
425 Davis St
Hammond, WI 54015-9615
Mailing address
425 Davis St
Hammond, WI 54015-9615
Phone (715) 296-2218
Other providers in Hammond, WI
- Gilhousen Chiropractic Health & Sports Center
- Michael Richard Gilhousen
- Melissa Herbst
- Michelle R Hoops
- Karla Lynn Jacobson
- Angela Rose Kjellberg
- Joyanne Marie Kohler
- Krista Demuth LLC
- Kristen Joy Kulig
- Mary Louise Larson
All providers in Hammond, WI · Occupational Therapy Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.