Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC003659 | PA |
NPI | 1003122102 |
---|---|
Provider Name | Alan Mortellaro |
First Address | Girard, PA 16417-8701 |
Second Address | Girard, PA 16417-8701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2010 |
Last Update Date | 26/08/2010 |