Provider Demographics
NPI:1659602548
Name:ALBERT, JENNIFER S (COTA/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:ALBERT
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 1:6252 INDIAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18092-2160
Mailing Address - Country:US
Mailing Address - Phone:484-788-1772
Mailing Address - Fax:
Practice Address - Street 1:98 HOSPITALITY DR
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641
Practice Address - Country:US
Practice Address - Phone:802-229-0308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP005896224Z00000X
VT073.0900225224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant