Provider Demographics
NPI:1083831267
Name:FIELDS, JACQUELINE ALVINA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ALVINA
Last Name:FIELDS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ALVINA
Other - Last Name:WESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4606 SOUTHAMPTON ARCH
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-1526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-6020
Practice Address - Fax:757-668-6025
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000948225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist