Provider Demographics
NPI:1093404196
Name:DE LA FUENTE, JUSTINE (OTR/L)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:DE LA FUENTE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-3809
Mailing Address - Country:US
Mailing Address - Phone:610-739-0166
Mailing Address - Fax:
Practice Address - Street 1:1925 W TURNER ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5513
Practice Address - Country:US
Practice Address - Phone:610-794-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist