Provider Demographics
NPI:1295986800
Name:ALLBAUGH, JODY (OTR)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:ALLBAUGH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 QUAIL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-8186
Mailing Address - Country:US
Mailing Address - Phone:570-992-3880
Mailing Address - Fax:
Practice Address - Street 1:13TH & BROOM STS
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4227
Practice Address - Country:US
Practice Address - Phone:610-356-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005073L225X00000X
DEU1-0000414225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist