Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 022875-1 | NY |
NPI | 1003390204 |
---|---|
Provider Name | Ianna Javier Garcia |
First Address | Syracuse, NY 13210 |
Second Address | Syracuse, NY 13215-2265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2018 |
Last Update Date | 24/09/2018 |