Individual
JACLYN OLIVIA FULFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 PHILADELPHIA AVE, SHILLINGTON, PA 19607-2764
(610) 777-7841
Mailing address
89 GRAYSON AVE, EAST EARL, PA 17519-9279
(717) 314-1171
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP010554
PA
Other
Enumeration date
04/16/2024
Last updated
04/16/2024
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