Provider Demographics
NPI:1346382231
Name:OETJEN, JAQUELINE ELEANOR (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JAQUELINE
Middle Name:ELEANOR
Last Name:OETJEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 SEASPRAY AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-4166
Mailing Address - Country:US
Mailing Address - Phone:904-866-7677
Mailing Address - Fax:
Practice Address - Street 1:7749 NORMANDY BLVD STE 147
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-7658
Practice Address - Country:US
Practice Address - Phone:904-786-5576
Practice Address - Fax:904-786-9907
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21865174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist