Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OP0035302 | PA |
NPI | 1952770596 |
---|---|
Provider Name | Annette Ifkovits |
First Address | Bethlehem, PA 18018-4940 |
Second Address | Bethlehem, PA 18018-4940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2015 |
Last Update Date | 24/09/2015 |