Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 003763-1 | NY |
NPI | 1013153204 |
---|---|
Provider Name | Faith Brennan |
First Address | Monroe, NY 10950-6449 |
Second Address | New City, NY 10956-4307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2008 |
Last Update Date | 18/12/2008 |