Provider Demographics
NPI:1316445034
Name:PALCZEWSKI, JENNA LEANN (OTRL)
Entity type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:LEANN
Last Name:PALCZEWSKI
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-9704
Mailing Address - Country:US
Mailing Address - Phone:269-762-0011
Mailing Address - Fax:
Practice Address - Street 1:1700 BRONSON WAY
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1095
Practice Address - Country:US
Practice Address - Phone:269-459-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010056225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist