Provider Demographics
NPI:1386278976
Name:VENTRIELLO, JIEUN (OTR/L)
Entity type:Individual
Prefix:
First Name:JIEUN
Middle Name:
Last Name:VENTRIELLO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JIEUN
Other - Middle Name:
Other - Last Name:WHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:121 FERNWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-4321
Mailing Address - Country:US
Mailing Address - Phone:856-332-2794
Mailing Address - Fax:
Practice Address - Street 1:121 FERNWOOD AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-4321
Practice Address - Country:US
Practice Address - Phone:856-332-2794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist