Provider Demographics
NPI:1689148009
Name:CINELLI, JENNIFER NOEL (COTA/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NOEL
Last Name:CINELLI
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 1:85 LLEWELLYN RD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-9072
Mailing Address - Country:US
Mailing Address - Phone:570-691-4687
Mailing Address - Fax:
Practice Address - Street 1:1502 ROUTE 61 HWY S
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-8409
Practice Address - Country:US
Practice Address - Phone:570-593-5484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
PAOP008332224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician