Provider Demographics
NPI:1063778785
Name:DAVIS, JENNIFER E (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WEST 11TH ST SUITE 401
Mailing Address - Street 2:NIAGARA THERAPY, LLC
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501
Mailing Address - Country:US
Mailing Address - Phone:814-464-0627
Mailing Address - Fax:814-464-0629
Practice Address - Street 1:240 W 11TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1758
Practice Address - Country:US
Practice Address - Phone:814-464-0627
Practice Address - Fax:814-464-0629
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011958225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist