Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 019804-1 | NY |
NPI | 1013465186 |
---|---|
Provider Name | David Marc Tagle |
First Address | Astoria, NY 11106-2329 |
Second Address | Scarsdale, NY 10583-4852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2016 |
Last Update Date | 16/09/2016 |