Provider Demographics
NPI:1194598904
Name:GRONEK, JENNA R (COTA/L)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:R
Last Name:GRONEK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 STRAIGHT ST
Mailing Address - Street 2:
Mailing Address - City:ELSBERRY
Mailing Address - State:MO
Mailing Address - Zip Code:63343-3503
Mailing Address - Country:US
Mailing Address - Phone:636-578-7352
Mailing Address - Fax:
Practice Address - Street 1:138 TOMAHAWK DR
Practice Address - Street 2:
Practice Address - City:ELSBERRY
Practice Address - State:MO
Practice Address - Zip Code:63343-1151
Practice Address - Country:US
Practice Address - Phone:573-898-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant