Provider Demographics
NPI:1518290618
Name:PRESTEGAARD PHILBIN, JENNIFER JEAN (JENNIFER PHILBIN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:PRESTEGAARD PHILBIN
Suffix:
Gender:F
Credentials:JENNIFER PHILBIN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JEAN
Other - Last Name:PRESTEGAARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JENNIFER PERHAMUS OT
Mailing Address - Street 1:77 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4029
Mailing Address - Country:US
Mailing Address - Phone:203-894-5130
Mailing Address - Fax:
Practice Address - Street 1:77 DANBURY RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4029
Practice Address - Country:US
Practice Address - Phone:203-894-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003827225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist