Provider Demographics
NPI:1144687575
Name:WILCHINSKI, JESSICA DILEO (OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DILEO
Last Name:WILCHINSKI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:DILEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8002 MYNELLE CT
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7114
Mailing Address - Country:US
Mailing Address - Phone:908-892-3154
Mailing Address - Fax:
Practice Address - Street 1:4000 APPLEGATE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2702
Practice Address - Country:US
Practice Address - Phone:980-343-1426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07426225X00000X
NC12578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist