Provider Demographics
NPI:1164784690
Name:TURK, JACQUELINE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:TURK
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:66-25 103RD ST. APT 7Z
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-8008
Mailing Address - Country:US
Mailing Address - Phone:914-263-6277
Mailing Address - Fax:
Practice Address - Street 1:6625 103RD ST APT 7Z
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-8008
Practice Address - Country:US
Practice Address - Phone:914-263-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017436-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist