Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP003059L | PA |
NPI | 1023308533 |
---|---|
Provider Name | Bonnie Ball |
First Address | Logan Twp, NJ 08085-1569 |
Second Address | Logan Twp, NJ 08085-1569 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2011 |
Last Update Date | 18/04/2011 |