Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 007525-1 | NY |
NPI | 1003135468 |
---|---|
Provider Name | Anastassiya Vigandt |
First Address | Brooklyn, NY 11235-3828 |
Second Address | Brooklyn, NY 11235-3828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2010 |
Last Update Date | 25/05/2010 |