Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OC005732L | PA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OC005732L | PA |
NPI | 1073148706 |
---|---|
Provider Name | Denise Redenski |
First Address | Nanticoke, PA 18634-2337 |
Second Address | Wilkes Barre, PA 18711-0026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2020 |
Last Update Date | 03/03/2020 |