Provider Demographics
NPI:1578865739
Name:HARTEN, JEANINE (MA,OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JEANINE
Middle Name:
Last Name:HARTEN
Suffix:
Gender:F
Credentials:MA,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:FORT SALONGA
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2508
Mailing Address - Country:US
Mailing Address - Phone:631-754-1099
Mailing Address - Fax:
Practice Address - Street 1:15 HASTINGS DR
Practice Address - Street 2:
Practice Address - City:FORT SALONGA
Practice Address - State:NY
Practice Address - Zip Code:11768-2508
Practice Address - Country:US
Practice Address - Phone:631-754-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-21
Last Update Date:2010-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007756172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker