Basic Information
| Provider Information | |||||||||
| NPI: | 1902082993 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERBACK | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 LOCUST ST STE 2A | ||||||||
| Address2: | |||||||||
| City: | CORAOPOLIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151083954 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 LOCUST ST STE 2A | ||||||||
| Address2: | |||||||||
| City: | CORAOPOLIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151083954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122990704 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2008 | ||||||||
| LastUpdateDate: | 08/25/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 0119003928 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 225XP0200X | OC006900L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.