Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 008612 | NY |
Y | 225X00000X | Occupational Therapist | 023611 | NY |
NPI | 1023473451 |
---|---|
Provider Name | Jennifer Conklin |
First Address | Poughkeepsie, NY 12603-1687 |
Second Address | Poughkeepsie, NY 12603-1687 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2015 |
Last Update Date | 29/03/2021 |