Provider Demographics
NPI:1922211770
Name:STOKES, JEANNINE LEIGH (OT)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:LEIGH
Last Name:STOKES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5619
Mailing Address - Country:US
Mailing Address - Phone:610-924-0652
Mailing Address - Fax:
Practice Address - Street 1:506 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5619
Practice Address - Country:US
Practice Address - Phone:610-924-0652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005107L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist