Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 022707 | NY |
NPI | 1194283747 |
---|---|
Provider Name | Julianne Roth |
First Address | Bardonia, NY 10954-1650 |
Second Address | Bardonia, NY 10954-1650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2019 |
Last Update Date | 03/03/2019 |