Provider Demographics
NPI:1932196110
Name:CASTELLI, JENNIFER LYNN (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:CASTELLI
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 DUFFER LOOP
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-3864
Mailing Address - Country:US
Mailing Address - Phone:863-471-0158
Mailing Address - Fax:863-471-1251
Practice Address - Street 1:123 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2100
Practice Address - Country:US
Practice Address - Phone:863-471-6303
Practice Address - Fax:863-471-1251
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3148225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8309OtherBLUE CROSS/BLUE SHIELD
FLZ8309ZMedicare ID - Type UnspecifiedMEDICARE