Healthcare Provider Details

I. General information

NPI: 1972610459
Provider Name (Legal Business Name): JACLYN M BROWN DROT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN M ROADRUCK OTR/L

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9951 MICKELBERRY RD NW STE 123
SILVERDALE WA
98383-8309
US

IV. Provider business mailing address

4225 PINE AVE NE
BREMERTON WA
98310-9793
US

V. Phone/Fax

Practice location:
  • Phone: 360-908-5110
  • Fax:
Mailing address:
  • Phone: 360-908-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1805
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT00003236
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00003236
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: