Healthcare Provider Details

I. General information

NPI: 1700659778
Provider Name (Legal Business Name): JOLYN AMBER RINEER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 HEISEY AVE
ELIZABETHTOWN PA
17022-8107
US

IV. Provider business mailing address

67 WIGEON WAY
ELIZABETHTOWN PA
17022-8850
US

V. Phone/Fax

Practice location:
  • Phone: 717-367-1831
  • Fax:
Mailing address:
  • Phone: 717-413-1365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP007258
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: