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General NPI Number Information
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NPI Number | 1992135578
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Entity Type | Individual
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Provider Name | JACQUELYN NICOLE-JAQUA SCHWANZ OTRL
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Gender | Female
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Dates
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Enumeration Date | 11/19/2013
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 112 HURON AVE
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City | HARRISVILLE
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State | MI
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Zip | 48740-9216
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Country | US
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Telephone | 989-572-9395
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Fax |
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Provider Business Mailing Address
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Address Line | 112 HURON AVE
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City | HARRISVILLE
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State | MI
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Zip | 48740-9216
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Country | US
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Telephone | 989-572-9395
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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 | OT013163
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 8380-26
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 6102
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201008132
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License Number State | MI
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