Provider Demographics
NPI:1831622380
Name:COHEN, JACQUELINE ASHLEY (MS OTR/L)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ASHLEY
Last Name:COHEN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HOULTON ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1901
Mailing Address - Country:US
Mailing Address - Phone:781-775-1069
Mailing Address - Fax:
Practice Address - Street 1:30 PRINCETON BLVD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2405
Practice Address - Country:US
Practice Address - Phone:978-454-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12281225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist