Most Relevant Information
Provider Data
| NPI Number: | 1003684119 |
| Provider Name: | JACQUELINE GRACE KETTLER OTR/L |
| Entity Type: | Individual |
| Taxonomy Code: | 225X00000X |
| Specialty: | Occupational Therapist |
| License Number: | 23228 |
Most Important Dates
| Enumeration Date: | 12/18/2023 |
| Last Updated: | 12/18/2023 |
Provider Practice Location
150 VILLAGE CROSSING CT
SAINT AUGUSTINE
FL
320848697
Practice Location Phone/Fax
| Phone: | 5026945241 |
| Fax: |
Provider Mailing Location
2121 GOLDEN LAKE LOOP
SAINT AUGUSTINE
FL
320845899
Provider Mailing Phone/Fax
| Phone: | 4173857650 |
| Fax: |