Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 46TA0009000100 | NJ |
NPI | 1023624798 |
---|---|
Provider Name | Aida E. Mendez-Boud |
First Address | Springfield, NJ 07081-3403 |
Second Address | Springfield, NJ 07081-3403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2020 |
Last Update Date | 18/09/2020 |