Provider Demographics
NPI:1831360569
Name:BURNINGHAM, JENNA GAIL (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:GAIL
Last Name:BURNINGHAM
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 1:4001 E BASELINE RD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2726
Mailing Address - Country:US
Mailing Address - Phone:480-539-5629
Mailing Address - Fax:
Practice Address - Street 1:4001 E BASELINE RD
Practice Address - Street 2:SUITE B2
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2726
Practice Address - Country:US
Practice Address - Phone:480-539-5629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4034225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist