Organization
JACQUELINE KOZAK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE KOZAK (OCCUPATIONAL THERAPIST)
(574) 361-7304
Entity
Organization
Contact information
Practice address
4402 WILLIAMS DR, 115, GEORGETOWN, TX 78628-1388
(512) 256-7627
Mailing address
4402 WILLIAMS DR STE 115, GEORGETOWN, TX 78628-1388
(512) 256-7627
Taxonomy
Speciality
Code
Description
License number
State
261QX0100X
Occupational Medicine Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15748686
CAQH
—
Enumeration date
11/01/2022
Last updated
12/09/2022
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