Provider Demographics
NPI:1902502982
Name:MOTLEY, JACQUELYN C
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:C
Last Name:MOTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JACQUELYN
Other - Middle Name:C
Other - Last Name:FLOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19750 HEYDEN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2059
Mailing Address - Country:US
Mailing Address - Phone:313-550-9993
Mailing Address - Fax:
Practice Address - Street 1:19750 HEYDEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2059
Practice Address - Country:US
Practice Address - Phone:313-550-9993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator