Provider Demographics
NPI:1164642690
Name:JENNIFER DOYLE OT LLC
Entity Type:Organization
Organization Name:JENNIFER DOYLE OT LLC
Other - Org Name:BETHLEHEM PEDIATRIC THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA OTIRL
Authorized Official - Phone:610-625-4404
Mailing Address - Street 1:701 WEST UNION BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018
Mailing Address - Country:US
Mailing Address - Phone:610-625-4404
Mailing Address - Fax:610-625-4261
Practice Address - Street 1:701 WEST UNION BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018
Practice Address - Country:US
Practice Address - Phone:610-625-4404
Practice Address - Fax:610-625-4261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009250225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016532650001Medicaid