Provider Demographics
NPI:1992882427
Name:SEARS, JENNY (OTR)
Entity type:Individual
Prefix:MS
First Name:JENNY
Middle Name:
Last Name:SEARS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 WHITE ROCK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-2047
Mailing Address - Country:US
Mailing Address - Phone:469-360-1716
Mailing Address - Fax:
Practice Address - Street 1:6805 NE LOOP 820
Practice Address - Street 2:SUITE 414
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76180-6687
Practice Address - Country:US
Practice Address - Phone:817-581-7246
Practice Address - Fax:817-581-7248
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109625225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist