Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 46TR00475200 | NJ |
NPI | 1003167545 |
---|---|
Provider Name | Jonathan Tapia |
First Address | Belleville, NJ 07109-5346 |
Second Address | Edison, NJ 08817-2684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2012 |
Last Update Date | 24/09/2012 |