Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0C011910 | PA |
NPI | 1003238197 |
---|---|
Provider Name | Lauren Zack |
First Address | Plains Twp, PA 18702-7927 |
Second Address | Plains Twp, PA 18702-7927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2014 |
Last Update Date | 09/01/2014 |