Provider Demographics
NPI:1952600033
Name:ALLEY, JENNIFER DIANE (OTA/L)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DIANE
Last Name:ALLEY
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HOSPITAL LN
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1329
Mailing Address - Country:US
Mailing Address - Phone:207-454-2544
Mailing Address - Fax:207-454-2932
Practice Address - Street 1:24 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1329
Practice Address - Country:US
Practice Address - Phone:207-454-2544
Practice Address - Fax:207-454-2932
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA2275224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant