Provider Demographics
NPI:1336392075
Name:GROMLEY, JACQUELINE MARIE (OTR, OT/L)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MARIE
Last Name:GROMLEY
Suffix:
Gender:F
Credentials:OTR, OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36247 VENCE DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8458
Mailing Address - Country:US
Mailing Address - Phone:714-943-5295
Mailing Address - Fax:
Practice Address - Street 1:27525 ENTERPRISE CIR W
Practice Address - Street 2:STE. 101C
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4884
Practice Address - Country:US
Practice Address - Phone:714-943-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004738225X00000X
CA7086225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist