Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 019677 | NY |
NPI | 1053746198 |
---|---|
Provider Name | Courtney North |
First Address | Canandaigua, NY 14424-1430 |
Second Address | Canandaigua, NY 14424-1430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2013 |
Last Update Date | 26/08/2015 |