Provider Demographics
NPI:1346706785
Name:BAHR, JACQUELINE ANNETTE
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ANNETTE
Last Name:BAHR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ANNETTE
Other - Last Name:PAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 FENWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-3615
Mailing Address - Country:US
Mailing Address - Phone:302-650-8908
Mailing Address - Fax:
Practice Address - Street 1:2801 W 6TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805
Practice Address - Country:US
Practice Address - Phone:302-655-6135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160007636225200000X
PATE011492225200000X
DEJ2-0001195225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant