Provider Demographics
NPI:1568257806
Name:VICTOR, JACQUELINE (OTR/L)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:VICTOR
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 CAPITAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-6482
Mailing Address - Country:US
Mailing Address - Phone:910-313-2111
Mailing Address - Fax:
Practice Address - Street 1:2116 CAPITAL DR STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-6482
Practice Address - Country:US
Practice Address - Phone:910-313-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17515225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist