Provider Demographics
NPI:1851610877
Name:DESPAIN, JACLYN SUZANNE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:SUZANNE
Last Name:DESPAIN
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:SUZANNE
Other - Last Name:TOOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:508 SW 161ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7696
Mailing Address - Country:US
Mailing Address - Phone:580-302-0058
Mailing Address - Fax:
Practice Address - Street 1:2002 E ROBINSON ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-7420
Practice Address - Country:US
Practice Address - Phone:405-307-2800
Practice Address - Fax:405-307-2801
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1881225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist