Provider Demographics
NPI:1881320034
Name:MRUGALSKI, JENELLE NICOLE (OTD, OTR)
Entity type:Individual
Prefix:DR
First Name:JENELLE
Middle Name:NICOLE
Last Name:MRUGALSKI
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 BACK BAY CT APT K
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-7547
Mailing Address - Country:US
Mailing Address - Phone:704-615-7738
Mailing Address - Fax:
Practice Address - Street 1:1140 TURNBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5862
Practice Address - Country:US
Practice Address - Phone:919-260-8438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics