Healthcare Provider Details

I. General information

NPI: 1679217210
Provider Name (Legal Business Name): JILL S GELINE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 FERNWOOD RD STE 506
BETHESDA MD
20817-1184
US

IV. Provider business mailing address

10215 FERNWOOD RD STE 506
BETHESDA MD
20817-1184
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-1010
  • Fax: 301-897-8597
Mailing address:
  • Phone: 301-530-1010
  • Fax: 301-962-7480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberT01254
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: