Provider Demographics
NPI:1861692030
Name:FENNEL, DINESE M (OTR/L)
Entity type:Individual
Prefix:MS
First Name:DINESE
Middle Name:M
Last Name:FENNEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:CREAM RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08514-2338
Mailing Address - Country:US
Mailing Address - Phone:609-758-3832
Mailing Address - Fax:
Practice Address - Street 1:524 WARDELL RD
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-7305
Practice Address - Country:US
Practice Address - Phone:732-922-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00194700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist