Provider Demographics
NPI:1831851534
Name:DINENNO, JESSICA MARIE (MOTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:DINENNO
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3271 SUTTON PL NW APT D
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-7540
Mailing Address - Country:US
Mailing Address - Phone:410-615-6018
Mailing Address - Fax:
Practice Address - Street 1:450 W BROAD ST STE 215
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3318
Practice Address - Country:US
Practice Address - Phone:703-533-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006463225XP0200X
DCOT010001323225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics