Provider Demographics
NPI:1669629234
Name:WHITNEY, JACQUELYN GAIL (OTR)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:GAIL
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2455
Mailing Address - Country:US
Mailing Address - Phone:603-750-2977
Mailing Address - Fax:603-834-6991
Practice Address - Street 1:307 PLAZA DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2455
Practice Address - Country:US
Practice Address - Phone:603-750-2977
Practice Address - Fax:603-834-6991
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0261225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist