Provider Demographics
NPI:1851936173
Name:DEJACIMO, MAUREEN WHELAN (OTR)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:WHELAN
Last Name:DEJACIMO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 MAHONEY DR
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3821
Mailing Address - Country:US
Mailing Address - Phone:732-608-3199
Mailing Address - Fax:
Practice Address - Street 1:2516 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1925
Practice Address - Country:US
Practice Address - Phone:732-223-6309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00351100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist