Provider Demographics
NPI:1073761573
Name:LENOIR, JENNIPHER M (COTA)
Entity type:Individual
Prefix:MRS
First Name:JENNIPHER
Middle Name:M
Last Name:LENOIR
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 1:4908 WILLOW RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-8238
Mailing Address - Country:US
Mailing Address - Phone:813-684-5000
Mailing Address - Fax:
Practice Address - Street 1:4908 WILLOW RIDGE TER
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-8238
Practice Address - Country:US
Practice Address - Phone:813-684-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10543224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant