Provider Demographics
NPI:1194502609
Name:SNETKOFF, JENNIFER (OTD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SNETKOFF
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2049 20TH LN APT 5F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6335
Mailing Address - Country:US
Mailing Address - Phone:718-702-2540
Mailing Address - Fax:
Practice Address - Street 1:2049 20TH LN APT 5F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6335
Practice Address - Country:US
Practice Address - Phone:718-702-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028228225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist