Healthcare Provider Details

I. General information

NPI: 1972693117
Provider Name (Legal Business Name): JENNIFER M DONNELLY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3995 E MARKET ST
YORK PA
17402-2773
US

IV. Provider business mailing address

3 EWELL DR
EAST BERLIN PA
17316-9307
US

V. Phone/Fax

Practice location:
  • Phone: 717-757-1227
  • Fax: 717-757-1353
Mailing address:
  • Phone: 717-259-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOC008176
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: