Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 023795 | NY |
NPI | 1053997593 |
---|---|
Provider Name | Jennifer Rose Demaria |
First Address | Floral Park, NY 11004-1410 |
Second Address | Floral Park, NY 11004-1410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2021 |
Last Update Date | 23/03/2021 |