Active NPI
Jennifer Elizabeth Matlack, OTR/L
- Occupational Therapist
- Lebanon, PA
National Provider Identifier
1497053482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OC011696
- Practice address
- 945 Duke St
Lebanon, PA 17042-7216 - Phone
- (717) 272-3092
- NPI assigned
- Mar 1, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OC011696 | PA | Primary |
Addresses
Primary practice location
945 Duke St
Lebanon, PA 17042-7216
Mailing address
318 Memorial Blvd
Newmanstown, PA 17073-9612
Phone (610) 589-6045
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OC011696 | PA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298937600000",
"number": "1497053482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "318 MEMORIAL BLVD",
"city": "NEWMANSTOWN",
"state": "PA",
"postal_code": "170739612",
"telephone_number": "610-589-6045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "945 DUKE ST",
"city": "LEBANON",
"state": "PA",
"postal_code": "170427216",
"telephone_number": "717-272-3092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATLACK",
"first_name": "JENNIFER",
"middle_name": "ELIZABETH",
"name_prefix": "Mrs.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-03-01",
"last_updated": "2011-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "PA",
"license": "OC011696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.