Provider Demographics
NPI:1881296937
Name:HEINEMAN, JACLYN A (OTR/L)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:A
Last Name:HEINEMAN
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 1:608 MONROEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1662
Mailing Address - Country:US
Mailing Address - Phone:856-472-2138
Mailing Address - Fax:
Practice Address - Street 1:608 MONROEVILLE RD
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-0808
Practice Address - Country:US
Practice Address - Phone:856-472-2138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics