Provider Demographics
NPI:1992954754
Name:PIEROTH, JENNIFER L (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:PIEROTH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17624 WESTBRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-6048
Mailing Address - Country:US
Mailing Address - Phone:708-532-5068
Mailing Address - Fax:
Practice Address - Street 1:17624 WESTBRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-6048
Practice Address - Country:US
Practice Address - Phone:708-532-5068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.002441225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics