Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0101741 | NY |
NPI | 1003052101 |
---|---|
Provider Name | Janice Sue Spencer |
First Address | Monroe, NY 10950-5243 |
Second Address | Monroe, NY 10950-5243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2008 |
Last Update Date | 20/12/2008 |