Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 007412-1 | NY |
NPI | 1003125527 |
---|---|
Provider Name | Amy Sommerville |
First Address | Latham, NY 12110-2442 |
Second Address | Albany, NY 12206-1069 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2010 |
Last Update Date | 01/10/2010 |