Individual
MRS. JORDAN MANNING PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4715 WHITESBURG DR SE, HUNTSVILLE, AL 35802-1649
(256) 705-4139
Mailing address
127 MADELYN DR, MERIDIANVILLE, AL 35759-1533
(256) 468-7384
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4169
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4169
OCCUPATIONAL THERAPIST LICENSE
AL
Enumeration date
03/30/2016
Last updated
09/25/2022
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