Provider Demographics
NPI:1386340909
Name:ANTHONY, JONATHAN R (OTR/L)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:R
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-6043
Mailing Address - Country:US
Mailing Address - Phone:484-866-3696
Mailing Address - Fax:
Practice Address - Street 1:510 BROOKMONT DR
Practice Address - Street 2:
Practice Address - City:EFFORT
Practice Address - State:PA
Practice Address - Zip Code:18330-9534
Practice Address - Country:US
Practice Address - Phone:610-681-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC018416225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist