Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC010193 | PA |
NPI | 1003132176 |
---|---|
Provider Name | Johanna Grossman |
First Address | Phoenixville, PA 19460-4823 |
Second Address | Norristown, PA 19401-3335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2010 |
Last Update Date | 14/04/2010 |