Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 006482 | NY |
NPI | 1003453127 |
---|---|
Provider Name | Andrea Passannante |
First Address | Oakdale, NY 11769-1910 |
Second Address | Bay Shore, NY 11706-8408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2019 |
Last Update Date | 09/12/2019 |