Provider Demographics
NPI:1922856947
Name:FORD, JACQUELINE PAIGE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:PAIGE
Last Name:FORD
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:PAIGE
Other - Last Name:EHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1502 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2148
Mailing Address - Country:US
Mailing Address - Phone:302-552-3796
Mailing Address - Fax:
Practice Address - Street 1:1621 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-4113
Practice Address - Country:US
Practice Address - Phone:302-434-6087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0001706225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics