Individual
JENNIFER MAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
501 SCHABOW ST, GRESHAM, WI 54128-9505
(715) 787-3211
Mailing address
223 W PARK ST, GILLETT, WI 54124-9414
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4901-27
WI
225X00000X
Occupational Therapist
Primary
6143-26
WI
Other
Enumeration date
10/16/2013
Last updated
05/04/2026
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