Individual
JACLYN INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSOT
Contact information
Practice address
233 ORANGEFAIR MALL, FULLERTON, CA 92832-3038
(710) 870-6116
Mailing address
233 ORANGEFAIR MALL, FULLERTON, CA 92832-3038
(714) 870-6116
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
23850
CA
Other
Enumeration date
05/11/2026
Last updated
05/11/2026
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