Provider Demographics
NPI:1376183798
Name:MALTBIE, JEREMIAH (OTR/L)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:MALTBIE
Suffix:
Gender:M
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 1:100 RAWLINS DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-5881
Mailing Address - Country:US
Mailing Address - Phone:302-362-5106
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:100 RAWLINS DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-5881
Practice Address - Country:US
Practice Address - Phone:302-629-6224
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU10001416225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist