Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 380338 | NY |
NPI | 1023530599 |
---|---|
Provider Name | Jilisa Henry |
First Address | Yonkers, NY 10710-5410 |
Second Address | Yonkers, NY 10710-5410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2017 |
Last Update Date | 16/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0646693726-8 | HEALTHCARE PROVIDER SERVICE (01) | NY |