Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 023001 | NY |
NPI | 1003416058 |
---|---|
Provider Name | Isaac Bulkley |
First Address | Binghamton, NY 13905 |
Second Address | Vestal, NY 13850-3556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2020 |
Last Update Date | 29/10/2020 |