Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 215690 | TX |
NPI | 1013582469 |
---|---|
Provider Name | Gina Marcella Castillo |
First Address | Scranton, PA 18505-2879 |
Second Address | Scranton, PA 18505-2879 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2021 |
Last Update Date | 26/05/2021 |