Provider Demographics
NPI:1710474333
Name:SCHACK, DANA (CPO)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:SCHACK
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 SE 17TH ST STE 401
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9140
Mailing Address - Country:US
Mailing Address - Phone:352-351-3207
Mailing Address - Fax:352-351-3267
Practice Address - Street 1:2300 SE 17TH ST STE 401
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-9140
Practice Address - Country:US
Practice Address - Phone:352-351-3207
Practice Address - Fax:352-351-3267
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR314222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist