Provider Demographics
NPI:1609359918
Name:ADEIGA, JONELLE ANTOINETTE (OT)
Entity type:Individual
Prefix:
First Name:JONELLE
Middle Name:ANTOINETTE
Last Name:ADEIGA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JONELLE
Other - Middle Name:ANTONETTE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6207 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1060
Mailing Address - Country:US
Mailing Address - Phone:512-454-3743
Mailing Address - Fax:512-334-4465
Practice Address - Street 1:6207 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1060
Practice Address - Country:US
Practice Address - Phone:512-454-3743
Practice Address - Fax:512-334-4465
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
TX110144225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist