MEDICARE: JENNIFER M HAINES OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT. 006951	OH

General Provider Information

NPI Number	:	1902139017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER M HAINES OTR/L

Provider Business Mailing Address
First Line	:	160 HUNTINGTON TRL
Second Line	:
City	:	CORTLAND
State	:	OH
Zip	:	44410-1600
Country	:	US
Telephone Number	:	330-637-3959
Fax Number	:

Provider Business Practice Location Address
First Line	:	3248 HENDERSON RD
Second Line	:	SUITE 2
City	:	COLUMBUS
State	:	OH
Zip	:	43220-7337
Country	:	US
Telephone Number	:	614-545-5500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	07/30/2014

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