Provider Demographics
NPI:1144564998
Name:PLANTE, JACQUELINE LEONA (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:LEONA
Last Name:PLANTE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-2210
Mailing Address - Country:US
Mailing Address - Phone:401-521-9600
Mailing Address - Fax:505-468-8285
Practice Address - Street 1:135 DODGE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-2210
Practice Address - Country:US
Practice Address - Phone:401-521-9600
Practice Address - Fax:505-468-8285
Is Sole Proprietor?:No
Enumeration Date:2012-11-18
Last Update Date:2012-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01046225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist