Provider Demographics
NPI:1366905945
Name:OHRNBERGER, JENNIFER L (COTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:OHRNBERGER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ROBINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-3206
Mailing Address - Country:US
Mailing Address - Phone:631-882-0068
Mailing Address - Fax:
Practice Address - Street 1:305 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1652
Practice Address - Country:US
Practice Address - Phone:631-218-5951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant