Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OC-003261-L | PA |
NPI | 1013152552 |
---|---|
Provider Name | Joseph David Palko |
First Address | Dunmore, PA 18512-2930 |
Second Address | Scranton, PA 18504-9728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2008 |
Last Update Date | 12/12/2008 |