Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 0127841 | NY |
NPI | 1235352931 |
---|---|
Provider Name | Jennifer Kennedy |
First Address | Bellmore, NY 11710-4052 |
Second Address | Albertson, NY 11507-1516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00274415 | (05) | NY |