Provider Demographics
NPI:1881990927
Name:PACK, VALERIE LYNNE (COTA)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:LYNNE
Last Name:PACK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 ROUTE 899
Mailing Address - Street 2:
Mailing Address - City:MARIENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16239-3625
Mailing Address - Country:US
Mailing Address - Phone:814-282-6106
Mailing Address - Fax:
Practice Address - Street 1:3000 NORTHWOODS PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-4708
Practice Address - Country:US
Practice Address - Phone:866-518-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007001224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant