Basic Information
Provider Information
NPI: 1114380334
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MYERS
FirstName: JENNIFER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MS, OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11 N 5 POINTS RD STE 2
Address2:  
City: WEST CHESTER
State: PA
PostalCode: 193804778
CountryCode: US
TelephoneNumber: 4842660387
FaxNumber:  
Practice Location
Address1: 11 N 5 POINTS RD STE 2
Address2:  
City: WEST CHESTER
State: PA
PostalCode: 193804778
CountryCode: US
TelephoneNumber: 4842660387
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/04/2016
LastUpdateDate: 09/25/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/25/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOC013930PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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