Healthcare Provider Details

I. General information

NPI: 1861689671
Provider Name (Legal Business Name): JACQUIE HEINRICH OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 E VALLEY PKWY
ESCONDIDO CA
92027-2932
US

IV. Provider business mailing address

600 S ANDREASEN DR SUITE C
ESCONDIDO CA
92029-1917
US

V. Phone/Fax

Practice location:
  • Phone: 760-233-9655
  • Fax: 760-233-9648
Mailing address:
  • Phone: 760-591-7750
  • Fax: 760-294-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT9392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: