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General NPI Number Information
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NPI Number | 1366909269
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Entity Type | Individual
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Provider Name | JENNIFER DANIELS
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Gender | Female
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 626 N TYNDALL PKWY
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City | PANAMA CITY
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State | FL
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Zip | 32404-6132
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Country | US
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Telephone | 850-871-6363
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Fax |
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Provider Business Mailing Address
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Address Line | 2103 AVENSONG LN # B103
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City | PANAMA CITY
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State | FL
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Zip | 32408-4471
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Country | US
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Telephone | 574-220-1155
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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