Provider Demographics
NPI:1174358337
Name:NAVARRO, JACQUELYNE (COTA/L)
Entity type:Individual
Prefix:
First Name:JACQUELYNE
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 THE RESORT PKWY UNIT 4422
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-9238
Mailing Address - Country:US
Mailing Address - Phone:909-231-5979
Mailing Address - Fax:
Practice Address - Street 1:9350 THE RESORT PKWY UNIT 4422
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-9238
Practice Address - Country:US
Practice Address - Phone:909-231-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6647224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant