Provider Demographics
NPI:1255337655
Name:FERCHALK, JENNIFER R (OTR)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:FERCHALK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15907-0338
Mailing Address - Country:US
Mailing Address - Phone:814-535-3656
Mailing Address - Fax:814-536-2096
Practice Address - Street 1:917 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1213
Practice Address - Country:US
Practice Address - Phone:814-443-2933
Practice Address - Fax:814-443-4695
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA085267QFHMedicare ID - Type Unspecified