Provider Demographics
NPI:1316198153
Name:MILLER, JENNIFER CHRISTINE (COTA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-1214
Mailing Address - Country:US
Mailing Address - Phone:570-288-9315
Mailing Address - Fax:
Practice Address - Street 1:200 2ND AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5722
Practice Address - Country:US
Practice Address - Phone:570-288-9315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006246224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant