Provider Demographics
NPI:1215203187
Name:JEQUINTO, TERRY ANNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:ANNE
Last Name:JEQUINTO
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 1:29038 DISCOVERY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-5757
Mailing Address - Country:US
Mailing Address - Phone:818-434-8149
Mailing Address - Fax:
Practice Address - Street 1:29038 DISCOVERY RIDGE DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91390-5757
Practice Address - Country:US
Practice Address - Phone:818-434-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 775172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker