Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OC002624L | PA |
Y | 225XH1200X | Occupational Therapist - Hand | OC002624L | PA |
NPI | 1174730642 |
---|---|
Provider Name | Jennifer M Haines |
First Address | King Of Prussia, PA 19406-3530 |
Second Address | King Of Prussia, PA 19406-3530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 23/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1452937 | PERSONAL CHOICE (01) | PA |
2138776000 | IBC - KEYSTONE (01) | PA |