Provider Demographics
NPI:1154551414
Name:DELOS SANTOS, JENNIFER (OTR/L)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:DELOS SANTOS
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:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:CROSSWICKS
Mailing Address - State:NJ
Mailing Address - Zip Code:08515-0255
Mailing Address - Country:US
Mailing Address - Phone:347-443-6524
Mailing Address - Fax:
Practice Address - Street 1:11524 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1717
Practice Address - Country:US
Practice Address - Phone:347-201-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
010957225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03143217Medicaid