Provider Demographics
NPI:1891568846
Name:GREENWOOD, JACQUELYN JOY (OTD, OTR)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:JOY
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 BISSONNET ST APT 4302
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1373
Mailing Address - Country:US
Mailing Address - Phone:281-725-7842
Mailing Address - Fax:
Practice Address - Street 1:11049 MEMORIAL HERMANN DR STE 150
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3305
Practice Address - Country:US
Practice Address - Phone:713-436-8869
Practice Address - Fax:713-436-1838
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124057225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist