Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC011440 | PA |
N | 225XG0600X | Occupational Therapist - Gerontology | OC011440 | PA |
NPI | 1174857643 |
---|---|
Provider Name | Dr. Jason John Castro |
First Address | Palmyra, PA 17078 |
Second Address | Palmyra, PA 17078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2009 |
Last Update Date | 12/02/2015 |