Provider Demographics
NPI:1316411085
Name:RHODES, JENNA LYNN
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:RHODES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17825 COLDSPRING RD
Mailing Address - Street 2:
Mailing Address - City:SPRING RUN
Mailing Address - State:PA
Mailing Address - Zip Code:17262-9716
Mailing Address - Country:US
Mailing Address - Phone:717-372-9881
Mailing Address - Fax:
Practice Address - Street 1:1000 CLAREMONT RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-7310
Practice Address - Country:US
Practice Address - Phone:717-240-1953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02456224Z00000X
PAOP008669224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant