Active NPI
Jaqueline Eleanor Oetjen, MPT
- Specialist
- Jacksonville, FL
National Provider Identifier
1346382231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- PT21865
- Practice address
- 7749 Normandy Blvd Ste 147
Jacksonville, FL 32221-7658 - Phone
- (904) 786-5576
- Fax
- (904) 786-9907
- NPI assigned
- Feb 13, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | PT21865 | FL | Primary |
Addresses
Primary practice location
7749 Normandy Blvd Ste 147
Jacksonville, FL 32221-7658
Mailing address
533 Seaspray Ave
Atlantic Beach, FL 32233-4166
Phone (904) 866-7677
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT21865 | FL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241654400000",
"number": "1346382231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "533 SEASPRAY AVE",
"city": "ATLANTIC BEACH",
"state": "FL",
"postal_code": "322334166",
"telephone_number": "904-866-7677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7749 NORMANDY BLVD STE 147",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322217658",
"telephone_number": "904-786-5576",
"fax_number": "904-786-9907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OETJEN",
"first_name": "JAQUELINE",
"middle_name": "ELEANOR",
"name_prefix": "Mrs.",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-13",
"last_updated": "2009-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "FL",
"license": "PT21865",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.