Provider Demographics
NPI:1710549134
Name:MAZALIC, DANIEL HARVEY
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:HARVEY
Last Name:MAZALIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8599 KNOX SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-9437
Mailing Address - Country:US
Mailing Address - Phone:330-323-9649
Mailing Address - Fax:
Practice Address - Street 1:8599 KNOX SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MINERVA
Practice Address - State:OH
Practice Address - Zip Code:44657-9437
Practice Address - Country:US
Practice Address - Phone:330-323-9649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No251E00000XAgenciesHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant