Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 12191 | MA |
Y | 225XG0600X | Occupational Therapist - Gerontology | 12191 | MA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 16542658 | CT |
N | 225XP0200X | Occupational Therapist - Pediatrics | 900839666 | MA |
NPI | 1083161145 |
---|---|
Provider Name | Amy Elizabeth Villalobos |
First Address | East Longmeadow, MA 01028-1906 |
Second Address | East Longmeadow, MA 01028-1906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2016 |
Last Update Date | 29/04/2021 |