Provider Demographics
NPI:1336648070
Name:LIMONGELLI, DEIDRE L (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:L
Last Name:LIMONGELLI
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ROOSEVELT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2572
Mailing Address - Country:US
Mailing Address - Phone:973-507-9730
Mailing Address - Fax:
Practice Address - Street 1:5 ROOSEVELT AVE STE A
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2572
Practice Address - Country:US
Practice Address - Phone:973-507-9730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00723000225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1790037463OtherKRISTEN CLARK