Provider Demographics
NPI:1932681863
Name:KRAMER, JEFFREY DANIEL
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DANIEL
Last Name:KRAMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DURYEA
Mailing Address - State:PA
Mailing Address - Zip Code:18642-1039
Mailing Address - Country:US
Mailing Address - Phone:570-457-9724
Mailing Address - Fax:
Practice Address - Street 1:516 SAINT MARYS VILLA RD
Practice Address - Street 2:
Practice Address - City:ELMHURST TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18444-9683
Practice Address - Country:US
Practice Address - Phone:570-842-7621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015083225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty