MEDICARE: JENNIFER LAITY

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	224Z00000X	Occupational Therapy Assistant	OP002949L	PA

General Provider Information

NPI Number	:	1801305156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LAITY

Provider Business Mailing Address
First Line	:	1574 THE HIDEOUT
Second Line	:
City	:	LAKE ARIEL
State	:	PA
Zip	:	18436-9562
Country	:	US
Telephone Number	:	302-299-8496
Fax Number	:

Provider Business Practice Location Address
First Line	:	1574 THE HIDEOUT
Second Line	:
City	:	LAKE ARIEL
State	:	PA
Zip	:	18436-9562
Country	:	US
Telephone Number	:	302-299-8496
Fax Number	:

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

Provider Enumeration Date	:	09/28/2017
Last Update Date	:	07/21/2022

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Directions to “ JENNIFER LAITY ” Practice Location

Language	Start Address	Practice Location

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