Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 024583 | NY |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 024583 | NY |
NPI | 1376179028 |
---|---|
Provider Name | Carissa Roca |
First Address | Great Neck, NY 11021-4802 |
Second Address | Great Neck, NY 11021-4802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2020 |
Last Update Date | 13/03/2020 |