Provider Demographics
NPI:1124364518
Name:SHIPE, JENNIFER N (OTR/L, MOT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:SHIPE
Suffix:
Gender:F
Credentials:OTR/L, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E KING ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-3272
Mailing Address - Country:US
Mailing Address - Phone:717-299-7877
Mailing Address - Fax:
Practice Address - Street 1:900 E KING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-3272
Practice Address - Country:US
Practice Address - Phone:717-299-7877
Practice Address - Fax:717-392-5118
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012640225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist