Healthcare Provider Details

I. General information

NPI: 1629103692
Provider Name (Legal Business Name): JENNIFER A DEGIROLOMO OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER A WEDICK OTR

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PROGRESS DR
SHELTON CT
06484-6293
US

IV. Provider business mailing address

10 PROGRESS DR STE 2B
SHELTON CT
06484-6294
US

V. Phone/Fax

Practice location:
  • Phone: 475-239-5512
  • Fax:
Mailing address:
  • Phone: 475-239-5512
  • Fax: 475-239-5513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number002295
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: