Provider Demographics
NPI:1689981706
Name:SARGENT, JACQUELINE KATE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:KATE
Last Name:SARGENT
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 1:98 LOWER WESTFIELD ROAD, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040
Mailing Address - Country:US
Mailing Address - Phone:413-532-1100
Mailing Address - Fax:413-532-2100
Practice Address - Street 1:98 LOWER WESTFIELD ROAD, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-532-1100
Practice Address - Fax:413-532-2100
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10122225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist