MEDICARE: DR. JENIN JOHN OTD, OTR/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
1	225X00000X	Occupational Therapist	OC014588	PA

General Provider Information

NPI Number	:	1760988851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENIN JOHN OTD, OTR/L

Provider Business Mailing Address
First Line	:	317 PEACHTREE DR
Second Line	:
City	:	JENKINTOWN
State	:	PA
Zip	:	19046-5002
Country	:	US
Telephone Number	:	267-886-4592
Fax Number	:

Provider Business Practice Location Address
First Line	:	2913 N 22ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-1505
Country	:	US
Telephone Number	:	215-422-3109
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2018
Last Update Date	:	04/05/2018

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