Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 46TR00336700 | NJ |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 46TR00336700 | NJ |
NPI | 1023349362 |
---|---|
Provider Name | Karen Graham |
First Address | Westfield, NJ 07090-2545 |
Second Address | Westfield, NJ 07090-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2010 |
Last Update Date | 27/01/2010 |