Provider Demographics
NPI:1922406321
Name:TUMBERELLO, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TUMBERELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:TUMBERELLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:6442 HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1507
Mailing Address - Country:US
Mailing Address - Phone:215-264-5513
Mailing Address - Fax:
Practice Address - Street 1:321 NORRISTOWN RD
Practice Address - Street 2:SUITE 220
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2755
Practice Address - Country:US
Practice Address - Phone:215-646-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001930L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist