Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 011329-1 | NY |
NPI | 1295227650 |
---|---|
Provider Name | Jennifer Lynn Gula |
First Address | Tonawanda, NY 14223-1407 |
Second Address | Tonawanda, NY 14223-1407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2018 |
Last Update Date | 01/06/2018 |