Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 009376 | NY |
NPI | 1023649639 |
---|---|
Provider Name | Gehan Botors |
First Address | Nutley, NJ 07110-1054 |
Second Address | Nutley, NJ 07110-1054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2020 |
Last Update Date | 01/02/2020 |