Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP007311 | PA |
NPI | 1023371580 |
---|---|
Provider Name | Elizabeth Joan Dolan |
First Address | Cranberry Twp, PA 16066-4239 |
Second Address | Cranberry Twp, PA 16066-4239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2012 |
Last Update Date | 20/06/2012 |