Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP002582L | PA |
NPI | 1033360243 |
---|---|
Provider Name | Joanne E. Bloom |
First Address | Sunbury, PA 17801-6071 |
Second Address | Sunbury, PA 17801-2818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2008 |
Last Update Date | 07/10/2008 |