Provider Demographics
NPI:1407593551
Name:THOMAS, DELEON (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:DELEON
Middle Name:
Last Name:THOMAS
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 1:610 NORTHUMBERLAND WAY
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2354
Mailing Address - Country:US
Mailing Address - Phone:347-397-7778
Mailing Address - Fax:
Practice Address - Street 1:610 NORTHUMBERLAND WAY
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-2354
Practice Address - Country:US
Practice Address - Phone:347-397-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01047600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist