Provider Demographics
NPI:1790990935
Name:STEYSKAL, JACQUELINE (OT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:STEYSKAL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 LAMBETH CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-6600
Mailing Address - Country:US
Mailing Address - Phone:910-793-2973
Mailing Address - Fax:910-395-5773
Practice Address - Street 1:3909 OLEANDER DR
Practice Address - Street 2:SUITE D
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6730
Practice Address - Country:US
Practice Address - Phone:910-547-4766
Practice Address - Fax:910-395-5773
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1041225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist