Provider Demographics
NPI:1720508831
Name:LAWRENCE, JEANNA MARIE (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:JEANNA
Middle Name:MARIE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 MOUNT MISERY RD
Mailing Address - Street 2:
Mailing Address - City:NEW OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:17350-9587
Mailing Address - Country:US
Mailing Address - Phone:1717-965-9292
Mailing Address - Fax:
Practice Address - Street 1:2990 CARLISLE PIKE
Practice Address - Street 2:
Practice Address - City:NEW OXFORD
Practice Address - State:PA
Practice Address - Zip Code:17350-9582
Practice Address - Country:US
Practice Address - Phone:717-624-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP008766224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant