Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1033635719 |
---|---|
Provider Name | Julianne Decicco |
First Address | Woodmere, NY 11598-1446 |
Second Address | Lagrangeville, NY 12540-5916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2017 |
Last Update Date | 15/11/2019 |