Provider Demographics
NPI:1285144683
Name:JACKOWAY, INGRID SCHWANTES (OTR)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:SCHWANTES
Last Name:JACKOWAY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:MILES
Other - Last Name:SCHWANTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 GREAT CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-2334
Mailing Address - Country:US
Mailing Address - Phone:302-235-1434
Mailing Address - Fax:
Practice Address - Street 1:2502 SILVERSIDE RD STE 4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3740
Practice Address - Country:US
Practice Address - Phone:302-478-3702
Practice Address - Fax:302-478-3703
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004045L225X00000X
DEU1-0000111225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist