Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jenna Nicole Derleth, OT

Individual provider Occupational Therapist · NPI 1902693807

Jenna Nicole Derleth, OT is an Occupational Therapist in Private Practice in Staten Island, New York. Qualified in 2024, 2 years ago. Practices with Sports Physical Therapy Occupational Therapy and Rehabilitation Servic, a 529-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
2
Licensed in
NY
In the registry since
2025
What do these letters mean?
OT — Occupational Therapist
Helps people regain the skills needed for daily living and work.

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Practice location Address checks out

3311 Hylan Blvd
Staten Island, NY 10306-3611
Phone: (718) 448-3210
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X · Licence 029970 (NY)

Record details

NPI number1902693807
Entity typeIndividual (Type 1)
GenderFemale
Credentials OT
Sole proprietorNo
NPI enumeratedApril 23, 2025
Last updated in NPPESApril 23, 2025
Certification dateApril 23, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOCCUPATIONAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Sports Physical Therapy Occupational Therapy And Rehabilitation Servic — 529 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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