Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | NY |
NPI | 1003399833 |
---|---|
Provider Name | Bonnie Redling |
First Address | Warwick, NY 10990-1925 |
Second Address | Slate Hill, NY 10973-4341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2018 |
Last Update Date | 07/09/2018 |