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General NPI Number Information
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NPI Number | 1164117875
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Entity Type | Individual
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Provider Name | JACQUELINE ROSE PAQUIN OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/07/2023
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Last Update Date | 04/07/2023
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Provider Practice Location Address
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Address Line | 2525 E SOUTHERN AVE
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City | TEMPE
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State | AZ
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Zip | 85282-7741
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Country | US
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Telephone | 480-831-3184
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Fax |
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Provider Business Mailing Address
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Address Line | 203 FAWNHILL RD
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City | BROOMALL
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State | PA
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Zip | 19008-1516
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Country | US
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Telephone | 610-742-2571
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTH-009102
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License Number State | AZ
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