Provider Demographics
NPI:1982941738
Name:CONNOLLY, JENINE RENEE (OTD)
Entity type:Individual
Prefix:DR
First Name:JENINE
Middle Name:RENEE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:JENINE
Other - Middle Name:RENEE
Other - Last Name:SHERIDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7205 YORKSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8091
Mailing Address - Country:US
Mailing Address - Phone:815-641-2559
Mailing Address - Fax:
Practice Address - Street 1:212 BARNEY DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5272
Practice Address - Country:US
Practice Address - Phone:815-725-2194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056016592225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist