Basic Information
| Provider Information | |||||||||
| NPI: | 1881903557 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SREDNI | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | YAEL | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5555 HOLLYWOOD BLVD | ||||||||
| Address2: | SUITE #201 | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330216476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546031881 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5555 HOLLYWOOD BLVD | ||||||||
| Address2: | SUITE #201 | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330216476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546031881 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2010 | ||||||||
| LastUpdateDate: | 02/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT17266 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 015661300 | 05 | FL | MEDICAID |