Basic Information
| Provider Information | |||||||||
| NPI: | 1073937371 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REINZO | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 49 WALNUT ST | ||||||||
| Address2: | BLDG 3 | ||||||||
| City: | WELLESLEY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024812117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812390100 | ||||||||
| FaxNumber: | 7812390102 | ||||||||
| Practice Location | |||||||||
| Address1: | 49 WALNUT ST | ||||||||
| Address2: | BLDG 3 | ||||||||
| City: | WELLESLEY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024812117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812390100 | ||||||||
| FaxNumber: | 7812390102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2014 | ||||||||
| LastUpdateDate: | 02/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 900001669 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.