Individual
DANIELLE N. JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5701 PHILLIPS AVE, PITTSBURGH, PA 15217-2254
(412) 422-5100
Mailing address
PO BOX 165, COWANSVILLE, PA 16218
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP006874
PA
Other
Enumeration date
04/28/2010
Last updated
04/28/2010
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