Individual
JACLYN AMBER DANNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
375 SW EGRET LNDG, PORT SAINT LUCIE, FL 34953-8225
(772) 342-1847
Mailing address
375 SW EGRET LNDG, PORT SAINT LUCIE, FL 34953-8225
(772) 342-1847
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OTA16773
—
FL
Enumeration date
10/09/2018
Last updated
10/09/2018
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