Healthcare Provider Details

I. General information

NPI: 1104033679
Provider Name (Legal Business Name): JENNIFER HOTALING OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S HENDERSON RD SUITE 200
KING OF PRUSSIA PA
19406-3530
US

IV. Provider business mailing address

700 S HENDERSON RD SUITE 200
KING OF PRUSSIA PA
19406-3530
US

V. Phone/Fax

Practice location:
  • Phone: 610-768-5940
  • Fax: 610-768-5947
Mailing address:
  • Phone: 610-768-5940
  • Fax: 610-768-5947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC003195L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOC003195L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: