Healthcare Provider Details

I. General information

NPI: 1154551414
Provider Name (Legal Business Name): JENNIFER DELOS SANTOS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 BROADWAY STE 212
UNION CITY NJ
07087-6544
US

IV. Provider business mailing address

PO BOX 255
CROSSWICKS NJ
08515-0255
US

V. Phone/Fax

Practice location:
  • Phone: 877-576-4681
  • Fax: 888-503-1237
Mailing address:
  • Phone: 347-443-6524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number010957
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: