Provider Demographics
NPI:1316930829
Name:BARILLO, JENNIFER A (OT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:BARILLO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:FERRIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:590 GRAVITY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-4136
Mailing Address - Country:US
Mailing Address - Phone:570-647-8445
Mailing Address - Fax:570-647-8445
Practice Address - Street 1:590 GRAVITY ROAD
Practice Address - Street 2:
Practice Address - City:LAKE ARIEL
Practice Address - State:PA
Practice Address - Zip Code:18436-4136
Practice Address - Country:US
Practice Address - Phone:570-647-8445
Practice Address - Fax:570-647-8445
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005834L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA843516OtherMANAGED PHYSICIAN NETWORK
NY843516OtherMANAGED PHYSICIAN NETWORK
NY843516OtherMANAGED PHYSICIAN NETWORK