Healthcare Provider Details

I. General information

NPI: 1164117875
Provider Name (Legal Business Name): JACQUELINE ROSE PAQUIN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 FAIRLAND RD
SILVER SPRING MD
20904-5427
US

IV. Provider business mailing address

203 FAWNHILL RD
BROOMALL PA
19008-1516
US

V. Phone/Fax

Practice location:
  • Phone: 301-384-6161
  • Fax:
Mailing address:
  • Phone: 610-742-2571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10722
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: