Healthcare Provider Details

I. General information

NPI: 1568590933
Provider Name (Legal Business Name): JARET BLAINE KERR MOTRL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SUMNER AVE
VANDERGRIFT PA
15690-1109
US

IV. Provider business mailing address

103 SUMNER AVE
VANDERGRIFT PA
15690-1109
US

V. Phone/Fax

Practice location:
  • Phone: 724-882-4491
  • Fax:
Mailing address:
  • Phone: 724-882-4491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC-005132L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: