Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 009897-1 | NY |
NPI | 1023570066 |
---|---|
Provider Name | Amanda R Bloom |
First Address | North Babylon, NY 11703-4706 |
Second Address | Oakdale, NY 11769-1652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2019 |
Last Update Date | 01/04/2019 |