Provider Demographics
NPI:1679299713
Name:ROOY, JENNA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:ROOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 ROSE MOSS CT SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3969
Mailing Address - Country:US
Mailing Address - Phone:301-275-4057
Mailing Address - Fax:423-702-4493
Practice Address - Street 1:37 BROCK DR
Practice Address - Street 2:
Practice Address - City:LOOKOUT MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30750-2207
Practice Address - Country:US
Practice Address - Phone:301-275-4057
Practice Address - Fax:423-702-4493
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist