Provider Demographics
NPI:1588909550
Name:HAUGHTON, JACQUELINE FOSTER (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:FOSTER
Last Name:HAUGHTON
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 1:29 BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1364
Mailing Address - Country:US
Mailing Address - Phone:860-490-4042
Mailing Address - Fax:
Practice Address - Street 1:1 HAMILTON HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-6320
Practice Address - Country:US
Practice Address - Phone:860-231-9375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0891224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant