Provider Demographics
NPI:1457984924
Name:EBBECKE, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:EBBECKE
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 1:23 PICKWICK LN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQ
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4607
Mailing Address - Country:US
Mailing Address - Phone:610-356-5745
Mailing Address - Fax:
Practice Address - Street 1:23 PICKWICK LN
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQ
Practice Address - State:PA
Practice Address - Zip Code:19073-4607
Practice Address - Country:US
Practice Address - Phone:610-476-8024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty