Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0216901 | NY |
NPI | 1023653599 |
---|---|
Provider Name | Heidi Moy |
First Address | Stony Point, NY 10980-1041 |
Second Address | Jamaica, NY 11432-3831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2019 |
Last Update Date | 08/11/2019 |