Provider Demographics
NPI:1730531344
Name:KAVANAGH, JEANNE ANN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:ANN
Last Name:KAVANAGH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:JEANNE
Other - Middle Name:ANN
Other - Last Name:POSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8775 N HOMESTEAD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:IRONS
Mailing Address - State:MI
Mailing Address - Zip Code:49644
Mailing Address - Country:US
Mailing Address - Phone:269-967-1915
Mailing Address - Fax:
Practice Address - Street 1:1000 E TINKHAM AVE
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1568
Practice Address - Country:US
Practice Address - Phone:232-845-6291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000908225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist