Provider Demographics
NPI:1881299147
Name:SHALONGO, JESSICA (OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SHALONGO
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 1:7 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:DE
Mailing Address - Zip Code:19934-1121
Mailing Address - Country:US
Mailing Address - Phone:302-698-4800
Mailing Address - Fax:
Practice Address - Street 1:594 VOSHELLS MILL STAR HILL RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-7609
Practice Address - Country:US
Practice Address - Phone:302-697-6117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
DEU1-0012235225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist