Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1603 | NH |
NPI | 1043509169 |
---|---|
Provider Name | Jill M Vinciguerra |
First Address | Greenland, NH 03840-2305 |
Second Address | Raymond, NH 03077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2011 |
Last Update Date | 29/03/2011 |