Healthcare Provider Details

I. General information

NPI: 1912829409
Provider Name (Legal Business Name): JENNIFER DEMETRO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CREE DR
LOCK HAVEN PA
17745-2639
US

IV. Provider business mailing address

1115 RENOVO RD
MILL HALL PA
17751-8520
US

V. Phone/Fax

Practice location:
  • Phone: 570-748-9377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: