Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 010530-1 | NY |
NPI | 1225366743 |
---|---|
Provider Name | John P Camilleri |
First Address | Whitesboro, NY 13492-2314 |
Second Address | Syracuse, NY 13210-2716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2009 |
Last Update Date | 21/11/2009 |