Provider Demographics
NPI:1922258755
Name:ROMERO, JAQUELINE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JAQUELINE
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 FOREST ROW
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1938
Mailing Address - Country:US
Mailing Address - Phone:516-570-2181
Mailing Address - Fax:516-498-9411
Practice Address - Street 1:69 FOREST ROW
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11024-1938
Practice Address - Country:US
Practice Address - Phone:516-570-2181
Practice Address - Fax:516-498-9411
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011201-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker