Provider Demographics
NPI:1063783165
Name:LAWRENCE, JENNA M (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:M
Last Name:LAWRENCE
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 1:7450 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:ABBOTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17301-8922
Mailing Address - Country:US
Mailing Address - Phone:717-586-1970
Mailing Address - Fax:
Practice Address - Street 1:7450 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:ABBOTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17301
Practice Address - Country:US
Practice Address - Phone:717-586-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007197224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant