Provider Demographics
NPI:1750652244
Name:FRIDAY, JACQUELINE OLIVIA (OTR/L MS)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:OLIVIA
Last Name:FRIDAY
Suffix:
Gender:F
Credentials:OTR/L MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:211 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-1822
Mailing Address - Country:US
Mailing Address - Phone:717-945-9960
Mailing Address - Fax:
Practice Address - Street 1:211 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-1822
Practice Address - Country:US
Practice Address - Phone:717-945-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOCO11783225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist