Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 46TA09121700 | NJ |
NPI | 1023566759 |
---|---|
Provider Name | Brian Meyers |
First Address | Newton, NJ 07860-1205 |
Second Address | Newton, NJ 07860-1205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2016 |
Last Update Date | 11/09/2016 |