Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1710549134 |
---|---|
Provider Name | Daniel Harvey Mazalic |
First Address | Minerva, OH 44657-9437 |
Second Address | Minerva, OH 44657-9437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2019 |
Last Update Date | 05/07/2019 |