Provider Demographics
NPI:1922276971
Name:WITTEN, JEANINE MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JEANINE
Middle Name:MARIE
Last Name:WITTEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GREYBIRCH RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3266
Mailing Address - Country:US
Mailing Address - Phone:978-689-8509
Mailing Address - Fax:
Practice Address - Street 1:8 GREYBIRCH RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3266
Practice Address - Country:US
Practice Address - Phone:978-689-8509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11684174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist