Individual
MR. JACOB GERARD VAXMONSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTLR
Contact information
Practice address
1315 MAIN ST, PORT GRIFFITH, PA 18640-1536
(570) 655-5697
Mailing address
1315 MAIN ST, PORT GRIFFITH, PA 18640-1536
(570) 655-5697
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC005082L
PA
Other
Enumeration date
10/09/2006
Last updated
07/08/2007
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