Individual
MRS. JENNIFER ANNA WISNIEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
300 LACKAWANNA AVE, SCRANTON, PA 18503-2001
(570) 961-3823
(570) 207-5988
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC005815L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
193439
MEDICARE
PA
Enumeration date
12/19/2006
Last updated
09/27/2023
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