Provider Demographics
NPI:1639519317
Name:JACKOWSKI, JENNIFER (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:JACKOWSKI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 HALLFORD ST
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-8037
Mailing Address - Country:US
Mailing Address - Phone:410-552-1559
Mailing Address - Fax:
Practice Address - Street 1:912 HALLFORD ST
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-8037
Practice Address - Country:US
Practice Address - Phone:410-552-1559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05094225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist