Healthcare Provider Details

I. General information

NPI: 1851020085
Provider Name (Legal Business Name): JESSICA DANKANICH MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2022
Last Update Date: 06/05/2022
Certification Date: 06/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 INDUSTRIAL BLVD STE 101
PAOLI PA
19301-1609
US

IV. Provider business mailing address

532 SUMMERCROFT DR
EXTON PA
19341-3047
US

V. Phone/Fax

Practice location:
  • Phone: 610-484-6232
  • Fax: 833-690-7898
Mailing address:
  • Phone: 717-873-2961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC010931
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: