Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1063693117 |
---|---|
Provider Name | Karen M. Stumpo |
First Address | Honesdale, PA 18431-1764 |
Second Address | Honesdale, PA 18431-4218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2007 |
Last Update Date | 16/11/2007 |