Provider Demographics
NPI:1063957306
Name:PUGH, JENNIE
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:PUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CLAYTON RD SUITE 1170
Mailing Address - Street 2:THERAPISTS UNLIMITED GENESIS HEALTHCARE COMPANY
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520
Mailing Address - Country:US
Mailing Address - Phone:925-726-0166
Mailing Address - Fax:610-347-4838
Practice Address - Street 1:2300 CLAYTON RD SUITE 1170
Practice Address - Street 2:THERAPISTS UNLIMITED GENESIS HEALTHCARE COMPANY
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520
Practice Address - Country:US
Practice Address - Phone:925-726-0166
Practice Address - Fax:610-347-4838
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA958224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant