Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 46TR01018700 | NJ |
NPI | 1003577016 |
---|---|
Provider Name | Grace Annmarie Petinakis |
First Address | East Hanover, NJ 07936-1315 |
Second Address | Springfield, NJ 07081-3403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2022 |
Last Update Date | 03/01/2022 |