Provider Demographics
NPI:1487070827
Name:CONNOR, JENNIFER ANNE (MS, LAT, ATC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANNE
Last Name:CONNOR
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:WETTIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LAT,ATC
Mailing Address - Street 1:914 PINETREE WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6608
Mailing Address - Country:US
Mailing Address - Phone:717-459-3057
Mailing Address - Fax:
Practice Address - Street 1:200 STANLEY AVE
Practice Address - Street 2:
Practice Address - City:LANDISVILLE
Practice Address - State:PA
Practice Address - Zip Code:17538-1220
Practice Address - Country:US
Practice Address - Phone:717-459-3057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0033542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer