Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 011657 | NY |
NPI | 1063961787 |
---|---|
Provider Name | Dr. Michele Lussier |
First Address | Putnam Valley, NY 10579-0144 |
Second Address | Putnam Valley, NY 10579-3003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2016 |
Last Update Date | 22/09/2016 |