Provider Demographics
NPI:1992492680
Name:WHITE, JENNA MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:KESNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1823
Mailing Address - Country:US
Mailing Address - Phone:315-600-1668
Mailing Address - Fax:
Practice Address - Street 1:75 BAYLEY RD
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-2578
Practice Address - Country:US
Practice Address - Phone:315-764-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027758-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist