Provider Demographics
NPI:1134707839
Name:MACIAS, JACQUELINE (OTR/L)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MACIAS
Suffix:
Gender:
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 1:525 W 24TH ST APT 2163
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2804
Mailing Address - Country:US
Mailing Address - Phone:915-667-0049
Mailing Address - Fax:
Practice Address - Street 1:2900 WOODRIDGE DR STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-2506
Practice Address - Country:US
Practice Address - Phone:713-741-5800
Practice Address - Fax:713-741-5805
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty