Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 019056 | NY |
NPI | 1023419397 |
---|---|
Provider Name | Alina Yusupova |
First Address | Rego Park, NY 11374-2646 |
Second Address | Rego Park, NY 11374-2646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2014 |
Last Update Date | 05/09/2014 |