Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XE0001X | Environmental Modification |
NPI | 1093297418 |
---|---|
Provider Name | Karlee Janine Mccorry |
First Address | Spencerport, NY 14559 |
Second Address | Wasilla, AK 99654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2018 |
Last Update Date | 01/09/2018 |