Provider Demographics
NPI:1982417192
Name:HARRIS, JENNA CHRISTINE (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:CHRISTINE
Last Name:HARRIS
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 1:1308 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-2119
Mailing Address - Country:US
Mailing Address - Phone:618-314-3956
Mailing Address - Fax:
Practice Address - Street 1:844 CAMBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1976
Practice Address - Country:US
Practice Address - Phone:618-624-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.016436225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist