Provider Demographics
NPI:1548700321
Name:KROEGER, JENNA MARIE (MOTR/L)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:MARIE
Last Name:KROEGER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:MISS
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:FAUROT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:8815 PIQUAD RD
Mailing Address - Street 2:
Mailing Address - City:ELIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-9441
Mailing Address - Country:US
Mailing Address - Phone:567-204-6488
Mailing Address - Fax:
Practice Address - Street 1:8815 PIQUAD RD
Practice Address - Street 2:
Practice Address - City:ELIDA
Practice Address - State:OH
Practice Address - Zip Code:45807-9441
Practice Address - Country:US
Practice Address - Phone:567-204-6488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT009270225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist