Basic Information
| Provider Information | |||||||||
| NPI: | 1205291358 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZEFF | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HAACK | ||||||||
| OtherFirstName: | JESSICA | ||||||||
| OtherMiddleName: | ELLEN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | OT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2400 WILDWOOD RD | ||||||||
| Address2: | |||||||||
| City: | GIBSONIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150446404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124877771 | ||||||||
| FaxNumber: | 4124877772 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 WILDWOOD RD | ||||||||
| Address2: | |||||||||
| City: | GIBSONIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150446404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124877771 | ||||||||
| FaxNumber: | 4124877772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2015 | ||||||||
| LastUpdateDate: | 06/19/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XP0200X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 225X00000X | OC014032 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 103116989-0001 | 05 | PA | MEDICAID |