Provider Demographics
NPI:1861177461
Name:KERPAN, JENNA ANN
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ANN
Last Name:KERPAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16626 S 14TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-4713
Mailing Address - Country:US
Mailing Address - Phone:949-257-7873
Mailing Address - Fax:
Practice Address - Street 1:16626 S 14TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-4713
Practice Address - Country:US
Practice Address - Phone:949-257-7873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist