Provider Demographics
NPI:1528687910
Name:FANELLI, JENNA LYNN (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LYNN
Last Name:FANELLI
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 1:1 BAYBERRY RD
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-1701
Mailing Address - Country:US
Mailing Address - Phone:914-450-1563
Mailing Address - Fax:
Practice Address - Street 1:55 FULMAR RD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-4512
Practice Address - Country:US
Practice Address - Phone:845-628-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024659225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist