Provider Demographics
NPI:1548416928
Name:HARTMAN, JENNIFER SUE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15176 TIMBER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEEDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:17238-8986
Mailing Address - Country:US
Mailing Address - Phone:814-617-0089
Mailing Address - Fax:
Practice Address - Street 1:15176 TIMBER RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEEDMORE
Practice Address - State:PA
Practice Address - Zip Code:17238-8986
Practice Address - Country:US
Practice Address - Phone:814-617-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-17
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006563314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility