Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 007915 | NY |
NPI | 1003195058 |
---|---|
Provider Name | Courtney Lynn Ricard |
First Address | Phoenix, NY 13135-1537 |
Second Address | Phoenix, NY 13135-1537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2011 |
Last Update Date | 09/08/2011 |