Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 015922-1 | NY |
NPI | 1043523509 |
---|---|
Provider Name | Alexandra Tsepenyuk |
First Address | Brooklyn, NY 11204-4088 |
Second Address | Brooklyn, NY 11204-4088 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2010 |
Last Update Date | 26/07/2010 |