Provider Demographics
NPI:1619731452
Name:MCCOURT, JENNIFER J (COTA/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:MCCOURT
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 1:121 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MINGO JUNCTION
Mailing Address - State:OH
Mailing Address - Zip Code:43938-1128
Mailing Address - Country:US
Mailing Address - Phone:740-381-3278
Mailing Address - Fax:
Practice Address - Street 1:308 BENITA DR # 3818470
Practice Address - Street 2:
Practice Address - City:MINGO JCT
Practice Address - State:OH
Practice Address - Zip Code:43938-1329
Practice Address - Country:US
Practice Address - Phone:740-381-8470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA01606224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty