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NPI Code Detail

MEDICARE: MRS. JENNA ELAINE HAYNES COTA/L

MEDICARE: MRS. JENNA ELAINE HAYNES COTA/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy AssistantOP007203PA

General Provider Information

NPI Number : 1033547906
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNA ELAINE HAYNES COTA/L
Provider Business Mailing Address
First Line : 316 ECKMONT AVE
Second Line :
City : SOUTH WILLIAMSPORT
State : PA
Zip : 17702-7709
Country : US
Telephone Number : 570-916-0061
Fax Number :
Provider Business Practice Location Address
First Line : 37 CENTRAL AVE
Second Line :
City : WELLSBORO
State : PA
Zip : 16901-1857
Country : US
Telephone Number : 570-724-3131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2013
Last Update Date : 10/31/2013

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