Provider Demographics
NPI:1487181251
Name:FOX, JACQUELYN ELIZABETH (OTD OTR/L APPLICANT)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:ELIZABETH
Last Name:FOX
Suffix:
Gender:F
Credentials:OTD OTR/L APPLICANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5932
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5215
Mailing Address - Country:US
Mailing Address - Phone:757-707-0805
Mailing Address - Fax:
Practice Address - Street 1:5700 WILLIAMSBURG LANDING DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5215
Practice Address - Country:US
Practice Address - Phone:757-565-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist