Provider Demographics
NPI:1326223462
Name:MOCK, JENNIFER LEIGH (MOT, OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:MOCK
Suffix:
Gender:F
Credentials:MOT, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 N MAYFAIR ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-1127
Mailing Address - Country:US
Mailing Address - Phone:509-462-8010
Mailing Address - Fax:509-462-8011
Practice Address - Street 1:5905 N MAYFAIR ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1127
Practice Address - Country:US
Practice Address - Phone:509-462-8010
Practice Address - Fax:509-462-8011
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATL10000801225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7680325Medicaid
WA99960OtherDEPT. OF LABOR & INDUSTRY
WA7680325Medicaid