Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 011096-1 | NY |
NPI | 1003128091 |
---|---|
Provider Name | Aviva Willig |
First Address | Brooklyn, NY 11210-4823 |
Second Address | Brooklyn, NY 11210-4823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2010 |
Last Update Date | 08/07/2010 |