1174730642 NPI number — JENIFER M HAINES OT

Table of content: JENIFER M HAINES OT (NPI 1174730642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174730642 NPI number — JENIFER M HAINES OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAINES
Provider First Name:
JENIFER
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174730642
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5228
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19380-0405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-359-5672
Provider Business Mailing Address Fax Number:
610-359-1519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 S HENDERSON RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
KING OF PRUSSIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19406-3530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-768-5940
Provider Business Practice Location Address Fax Number:
610-768-5947
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OC002624L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X , with the licence number: OC002624L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1452937 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2138776000 . This is a "IBC - KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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