Individual
JACQUELINE D DAFONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2600 COMPASS RD, GLENVIEW, IL 60026-8001
(877) 787-3430
Mailing address
66 BATTLES FARM DR, BROCKTON, MA 02301-2216
(508) 309-2815
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
14123
MA
Other
Enumeration date
11/19/2021
Last updated
11/19/2021
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