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General NPI Number Information
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NPI Number | 1912829409
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Entity Type | Individual
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Provider Name | JENNIFER DEMETRO
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Gender |
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 22 CREE DR
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City | LOCK HAVEN
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State | PA
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Zip | 17745-2639
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Country | US
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Telephone | 570-748-9377
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 RENOVO RD
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City | MILL HALL
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State | PA
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Zip | 17751-8520
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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