Individual
MRS. BREAUANNA NINA JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
425 DAVIS ST, HAMMOND, WI 54015-9615
(715) 796-2218
Mailing address
425 DAVIS ST, HAMMOND, WI 54015-9615
(715) 296-2218
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5409
WI
Other
Enumeration date
08/16/2017
Last updated
08/16/2017
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