Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OC012852 | PA |
NPI | 1275187221 |
---|---|
Provider Name | Grace Bernadette Farrelly |
First Address | Broomall, PA 19008-3805 |
Second Address | Philadelphia, PA 19131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2019 |
Last Update Date | 29/07/2019 |