Provider Demographics
NPI:1326159039
Name:OLIN, JACQUELINE MORGAN (PT)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MORGAN
Last Name:OLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 NEPONSET AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-3169
Mailing Address - Country:US
Mailing Address - Phone:774-218-5585
Mailing Address - Fax:561-603-6450
Practice Address - Street 1:1234 HYDE PARK AVE STE 204
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2819
Practice Address - Country:US
Practice Address - Phone:617-874-2225
Practice Address - Fax:617-910-9598
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000Y61011OtherBCBS GROUP
612930OtherTUFTS GROUP
Y67137OtherBCBS INDVID
613542OtherHARVARD PILGRIM GROUP
Y67137OtherBCBS INDVID