Provider Demographics
NPI:1457678716
Name:JONES, YVETTE MARIE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:YVETTE
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 1111
Mailing Address - Street 2:RT 92
Mailing Address - City:NICHOLSON
Mailing Address - State:PA
Mailing Address - Zip Code:18446-9709
Mailing Address - Country:US
Mailing Address - Phone:570-942-4570
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 1111
Practice Address - Street 2:RT 92
Practice Address - City:NICHOLSON
Practice Address - State:PA
Practice Address - Zip Code:18446-9709
Practice Address - Country:US
Practice Address - Phone:570-942-4570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0C002227-L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9166671991Medicaid
PA9166671990Medicare NSC
PA9166671992Medicare Oscar/Certification
PA9166671991Medicaid