Provider Demographics
NPI:1114925187
Name:NEIHEISER, JENNIFER L (OT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:NEIHEISER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FAIRLANE RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-9567
Mailing Address - Country:US
Mailing Address - Phone:610-779-2663
Mailing Address - Fax:610-779-3367
Practice Address - Street 1:11 FAIRLANE RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-9567
Practice Address - Country:US
Practice Address - Phone:610-779-2663
Practice Address - Fax:610-779-3367
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002745L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
035961D97Medicare ID - Type Unspecified
P01075Medicare UPIN