Provider Demographics
NPI:1306925714
Name:KOVANIS, JENNIFER F (MS OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:F
Last Name:KOVANIS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 AMSTER GREEN DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4139
Mailing Address - Country:US
Mailing Address - Phone:770-698-9504
Mailing Address - Fax:770-698-4178
Practice Address - Street 1:1000 HOLCOMB WOODS PKWY STE 422
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4718
Practice Address - Country:US
Practice Address - Phone:770-641-8070
Practice Address - Fax:770-698-4178
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003002225XP0200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000858844CMedicaid