Basic Information
| Provider Information | |||||||||
| NPI: | 1144564998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLANTE | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | LEONA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 DODGE ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029072210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015219600 | ||||||||
| FaxNumber: | 5054688285 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 DODGE ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029072210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015219600 | ||||||||
| FaxNumber: | 5054688285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2012 | ||||||||
| LastUpdateDate: | 11/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT01046 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.