Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0205061 | NY |
NPI | 1003266818 |
---|---|
Provider Name | Giovanna Ciccone |
First Address | Bronx, NY 10461-9800 |
Second Address | West Nyack, NY 10994-1025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2016 |
Last Update Date | 13/06/2016 |