Provider Demographics
NPI:1760988851
Name:JOHN, JENIN (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:JENIN
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 PEACHTREE DR
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-5002
Mailing Address - Country:US
Mailing Address - Phone:267-886-4592
Mailing Address - Fax:
Practice Address - Street 1:2913 N 22ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-1505
Practice Address - Country:US
Practice Address - Phone:215-422-3109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014588225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist