Provider Demographics
NPI:1306410998
Name:YAGUAL FLORES, JACKELINE MICHELLE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JACKELINE
Middle Name:MICHELLE
Last Name:YAGUAL FLORES
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7209 CREEDMOOR RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1695
Mailing Address - Country:US
Mailing Address - Phone:919-844-1100
Mailing Address - Fax:919-844-1102
Practice Address - Street 1:7209 CREEDMOOR RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1695
Practice Address - Country:US
Practice Address - Phone:919-844-1100
Practice Address - Fax:919-844-1102
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13977225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist