Healthcare Provider Details

I. General information

NPI: 1295870756
Provider Name (Legal Business Name): MILDRED GRACE CILENTO OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 NEW LINDEN HILL RD
WILMINGTON DE
19808-2930
US

IV. Provider business mailing address

4550 NEW LINDEN HILL RD
WILMINGTON DE
19808-2930
US

V. Phone/Fax

Practice location:
  • Phone: 302-552-3700
  • Fax:
Mailing address:
  • Phone: 302-552-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberU1-0000026
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: