Provider Demographics
NPI:1831691625
Name:PINE, JORDAN ALEXIS (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:ALEXIS
Last Name:PINE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13826 FORT LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:MERCERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17236-8505
Mailing Address - Country:US
Mailing Address - Phone:814-932-2718
Mailing Address - Fax:
Practice Address - Street 1:214 PEACH ORCHARD ROAD
Practice Address - Street 2:
Practice Address - City:MCCONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233
Practice Address - Country:US
Practice Address - Phone:717-485-6108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015162225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist