Provider Demographics
NPI:1932742301
Name:KIRBY, JACQUELINE COURTNEY (MA, OTR/L)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:COURTNEY
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5903 CAPE HATTERAS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-5911
Mailing Address - Country:US
Mailing Address - Phone:832-360-7535
Mailing Address - Fax:
Practice Address - Street 1:5903 CAPE HATTERAS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-5911
Practice Address - Country:US
Practice Address - Phone:832-360-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120211225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics