Provider Demographics
NPI:1427271139
Name:HALEY, JENNIFER CATHERINE (COTA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CATHERINE
Last Name:HALEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:324 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALDAN
Mailing Address - State:PA
Mailing Address - Zip Code:19018-4221
Mailing Address - Country:US
Mailing Address - Phone:610-623-1990
Mailing Address - Fax:610-461-3558
Practice Address - Street 1:1412 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1218
Practice Address - Country:US
Practice Address - Phone:610-461-6510
Practice Address - Fax:610-461-3558
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP001926L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant