Provider Demographics
NPI:1023654159
Name:SNOUFFER, JACQUELYN DIANE
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:DIANE
Last Name:SNOUFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 E PENNSYVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:YOE
Mailing Address - State:PA
Mailing Address - Zip Code:17313-1213
Mailing Address - Country:US
Mailing Address - Phone:717-873-0821
Mailing Address - Fax:717-650-3885
Practice Address - Street 1:7 E PENNSYVANIA AVE
Practice Address - Street 2:
Practice Address - City:YOE
Practice Address - State:PA
Practice Address - Zip Code:17313-1213
Practice Address - Country:US
Practice Address - Phone:717-873-0821
Practice Address - Fax:717-650-3885
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9516404225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist