Provider Demographics
NPI:1487785200
Name:MAGINN, JACQUELINE K (OTR)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:K
Last Name:MAGINN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:K
Other - Last Name:FRENCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:12555 PARTRIDGE RUN DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-5015
Mailing Address - Country:US
Mailing Address - Phone:314-741-4126
Mailing Address - Fax:314-741-4450
Practice Address - Street 1:12555 PARTRIDGE RUN DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-5015
Practice Address - Country:US
Practice Address - Phone:314-741-4126
Practice Address - Fax:314-741-4450
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003896225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist