Provider Demographics
NPI:1225077787
Name:BRITTON, JACQUELINE M (OTR)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:BRITTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2654
Mailing Address - Country:US
Mailing Address - Phone:814-455-0995
Mailing Address - Fax:814-455-0997
Practice Address - Street 1:2402 CHERRY ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2654
Practice Address - Country:US
Practice Address - Phone:814-455-0995
Practice Address - Fax:814-455-0997
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA177229000Medicaid
PA064204Q4YOtherID NUMBER
P92047Medicare UPIN