Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP006379 | PA |
NPI | 1013032531 |
---|---|
Provider Name | Charelle Petrone |
First Address | Feasterville Trevose, PA 19053-2369 |
Second Address | Lower Gwynedd, PA 19002-2125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |