Provider Demographics
NPI:1477750214
Name:MAHUTE, JENNIFER LYNN (OTD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:MAHUTE
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:16617-2130
Mailing Address - Country:US
Mailing Address - Phone:814-502-0057
Mailing Address - Fax:
Practice Address - Street 1:500 E MARYLYN AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-272-2137
Practice Address - Fax:814-272-2156
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC 008948225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist