Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 007867-01 | NY |
NPI | 1003499849 |
---|---|
Provider Name | Douglas A Gahan |
First Address | N Syracuse, NY 13212-3611 |
Second Address | N Syracuse, NY 13212-3611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2021 |
Last Update Date | 29/04/2021 |