Provider Demographics
NPI:1689110090
Name:DEGENKOLB, BILLIEJO
Entity Type:Individual
Prefix:
First Name:BILLIEJO
Middle Name:
Last Name:DEGENKOLB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-4350
Mailing Address - Country:US
Mailing Address - Phone:304-670-4839
Mailing Address - Fax:
Practice Address - Street 1:60 BRIMLEY DRIVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406
Practice Address - Country:US
Practice Address - Phone:540-737-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP008812224Z00000X
VA0131001736224Z00000X
MDA02751224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant