Provider Demographics
NPI:1114503935
Name:TWOMBLY, JACQUELINE A (OT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:TWOMBLY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SEAPORT DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1599
Mailing Address - Country:US
Mailing Address - Phone:617-769-5100
Mailing Address - Fax:
Practice Address - Street 1:2 SEAPORT DR
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-1599
Practice Address - Country:US
Practice Address - Phone:617-769-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3025225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist