Provider Demographics
NPI:1659797736
Name:TSCHANTZ, JACLYN KATHLEEN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:KATHLEEN
Last Name:TSCHANTZ
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 1:4 E CENTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1072
Mailing Address - Country:US
Mailing Address - Phone:570-675-6800
Mailing Address - Fax:570-675-8919
Practice Address - Street 1:4 E CENTER HILL RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1072
Practice Address - Country:US
Practice Address - Phone:570-675-8600
Practice Address - Fax:570-675-8919
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012953225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist