Provider Demographics
NPI:1558066761
Name:TANTILLO, JENNIE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:
Last Name:TANTILLO
Suffix:
Gender:
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 1:8200 SAVAGE GUILFORD RD
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20763-5671
Mailing Address - Country:US
Mailing Address - Phone:410-880-5920
Mailing Address - Fax:410-880-5923
Practice Address - Street 1:8200 SAVAGE GUILFORD RD
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MD
Practice Address - Zip Code:20763-5671
Practice Address - Country:US
Practice Address - Phone:410-880-5920
Practice Address - Fax:410-880-5923
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09935225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist