Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 46TR00604400 | NJ |
NPI | 1003479981 |
---|---|
Provider Name | Emily Dequinzio |
First Address | Verona, NJ 07044-1611 |
Second Address | Wayne, NJ 07470-4081 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2019 |
Last Update Date | 17/04/2019 |