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NPI Code Detail

MEDICARE: JACLYN MARIE ONKS MS, ATC

MEDICARE: JACLYN MARIE ONKS MS, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerRT003617PA

General Provider Information

NPI Number : 1639135916
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACLYN MARIE ONKS MS, ATC
Provider Business Mailing Address
First Line : 240 E MONTGOMERY AVE
Second Line : UNIT 7
City : ARDMORE
State : PA
Zip : 19003-3322
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1733 W GIRARD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19130-1513
Country : US
Telephone Number : 215-978-1972
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 07/08/2007

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