Basic Information
| Provider Information | |||||||||
| NPI: | 1265660682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOCHENEK | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11426 NANCY DR | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480936430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5865583712 | ||||||||
| FaxNumber: | 5865583712 | ||||||||
| Practice Location | |||||||||
| Address1: | 14145 SIMONE DR | ||||||||
| Address2: | |||||||||
| City: | SHELBY TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483153228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5865666280 | ||||||||
| FaxNumber: | 5865666280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2009 | ||||||||
| LastUpdateDate: | 06/24/2009 | ||||||||
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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 | 224Z00000X | 5202007170 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.