Provider Demographics
NPI:1881304483
Name:PELONERO, JENNA NICOLE (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:NICOLE
Last Name:PELONERO
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 1:509 MEMORIAL DR APT 209
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-5177
Mailing Address - Country:US
Mailing Address - Phone:732-320-0098
Mailing Address - Fax:
Practice Address - Street 1:96 FOREST ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-3907
Practice Address - Country:US
Practice Address - Phone:978-532-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA115433225X00000X
NJ46TR01068400225X00000X
MA14768225X00000X
PAOC018501225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist