Provider Demographics
NPI:1174730642
Name:HAINES, JENIFER M (OT)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:M
Last Name:HAINES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5228
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-0405
Mailing Address - Country:US
Mailing Address - Phone:610-359-5672
Mailing Address - Fax:610-359-1519
Practice Address - Street 1:700 S HENDERSON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3530
Practice Address - Country:US
Practice Address - Phone:610-768-5940
Practice Address - Fax:610-768-5947
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002624L225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1452937OtherPERSONAL CHOICE
PA2138776000OtherIBC - KEYSTONE