Provider Demographics
NPI:1689981706
Name:ANTONELLIS, JACQUELINE SARGENT (OTR/L)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SARGENT
Last Name:ANTONELLIS
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 1:9 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-1129
Mailing Address - Country:US
Mailing Address - Phone:508-212-0981
Mailing Address - Fax:
Practice Address - Street 1:9 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01519-1129
Practice Address - Country:US
Practice Address - Phone:508-212-0981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10122225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist