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NPI Code Detail

MEDICARE: MRS. JAQUELINE ELEANOR OETJEN MPT

MEDICARE: MRS. JAQUELINE ELEANOR OETJEN MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistPT21865FL

General Provider Information

NPI Number : 1346382231
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JAQUELINE ELEANOR OETJEN MPT
Provider Business Mailing Address
First Line : 533 SEASPRAY AVE
Second Line :
City : ATLANTIC BEACH
State : FL
Zip : 32233-4166
Country : US
Telephone Number : 904-866-7677
Fax Number :
Provider Business Practice Location Address
First Line : 7749 NORMANDY BLVD STE 147
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32221-7658
Country : US
Telephone Number : 904-786-5576
Fax Number : 904-786-9907
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2007
Last Update Date : 05/07/2009

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Directions to “ MRS. JAQUELINE ELEANOR OETJEN MPT” Practice Location

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