Provider Demographics
NPI:1205998986
Name:SANTANGELO, JACLYN A (MOT)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:A
Last Name:SANTANGELO
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:MISS
Other - First Name:JACLYN
Other - Middle Name:A
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:301 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9063
Mailing Address - Country:US
Mailing Address - Phone:304-757-3240
Mailing Address - Fax:
Practice Address - Street 1:3705 TEAYS VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9645
Practice Address - Country:US
Practice Address - Phone:304-757-2500
Practice Address - Fax:304-757-2586
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV001014225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1714909OtherBLUE CROSS BLUE SHIELD
WV7104487OtherAETNA
WV1062861OtherWORKERS COMP
WV7503100-000Medicaid
WV311504453OtherCIGNA
WV311504453OtherACORDIA
WV311504453OtherACORDIA
WARE4116062Medicare ID - Type UnspecifiedMILTON, WV CLINIC
WV311504453OtherCIGNA