Provider Demographics
NPI:1407285034
Name:FREEMAN, JACQUELINE ANN (MSOTR)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:ANN
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MSOTR
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ANN
Other - Last Name:KETTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTR/L
Mailing Address - Street 1:412 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1901
Mailing Address - Country:US
Mailing Address - Phone:810-236-7500
Mailing Address - Fax:
Practice Address - Street 1:412 E 1ST ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1901
Practice Address - Country:US
Practice Address - Phone:810-236-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2479280225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation