Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 017688-1 | NY |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1735 | MA |
NPI | 1144560178 |
---|---|
Provider Name | Debra Latour |
First Address | Middletown, NY 10941-4064 |
Second Address | Middletown, NY 10941-4064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2013 |
Last Update Date | 22/05/2014 |