Provider Demographics
NPI:1770190563
Name:CASTILLO, JENNIFER (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
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 1:1900 W. ALPHA COURT
Mailing Address - Street 2:APT 211
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-7507
Mailing Address - Country:US
Mailing Address - Phone:516-545-1610
Mailing Address - Fax:
Practice Address - Street 1:1900 W. ALPHA COURT
Practice Address - Street 2:APT 211
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-7507
Practice Address - Country:US
Practice Address - Phone:516-545-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-26
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist