Provider Demographics
NPI:1174877567
Name:WEINSTOCK, JENNIFER ELLEN (MS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELLEN
Last Name:WEINSTOCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 FREEMAN ST
Mailing Address - Street 2:APT. #2
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-6613
Mailing Address - Country:US
Mailing Address - Phone:781-248-7606
Mailing Address - Fax:
Practice Address - Street 1:10J GILL ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1721
Practice Address - Country:US
Practice Address - Phone:781-932-2888
Practice Address - Fax:781-932-9809
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7783225X00000X
NJ46TR00393700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist