Provider Demographics
NPI:1053883892
Name:JENEAULT, MORGAN RENEE (COTA/L)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:RENEE
Last Name:JENEAULT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 MIDDLE CHESHIRE RD
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2470
Mailing Address - Country:US
Mailing Address - Phone:585-394-5070
Mailing Address - Fax:
Practice Address - Street 1:3220 MIDDLE CHESHIRE RD
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2470
Practice Address - Country:US
Practice Address - Phone:585-394-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010003-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant