Individual
MS. JACQUELINE KODISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4025 CHESTNUT ST, PHILADELPHIA, PA 19104-3081
(267) 225-6714
Mailing address
850 TOWBIN AVE, LAKEWOOD, NJ 08701-5928
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
07/09/2019
Last updated
08/10/2022
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