Provider Demographics
NPI:1962535930
Name:MONTEIRO, JACLYN S (OTR)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:S
Last Name:MONTEIRO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:JACLYN
Other - Middle Name:ANN
Other - Last Name:SCHEFFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:13133 LANGTREE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1044
Mailing Address - Country:US
Mailing Address - Phone:804-360-3474
Mailing Address - Fax:
Practice Address - Street 1:4101 NINE MILE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-4916
Practice Address - Country:US
Practice Address - Phone:804-222-1694
Practice Address - Fax:804-222-1164
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000199225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist