Provider Demographics
NPI:1841753977
Name:PERRY, JACQUELINE CHRISTINE
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:CHRISTINE
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 BUCKHORN RD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-9303
Mailing Address - Country:US
Mailing Address - Phone:410-795-2737
Mailing Address - Fax:
Practice Address - Street 1:1442 BUCKHORN RD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-9303
Practice Address - Country:US
Practice Address - Phone:410-795-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-06
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16503224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant