Healthcare Provider Details

I. General information

NPI: 1720522758
Provider Name (Legal Business Name): JACQUELYN REPICE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FLAGSTONE RD
CHESTER SPRINGS PA
19425-3826
US

IV. Provider business mailing address

9801 GERMANTOWN PIKE APT 822
LAFAYETTE HILL PA
19444-1102
US

V. Phone/Fax

Practice location:
  • Phone: 610-241-2685
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC014371
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: