Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0717371-1 | NY |
NPI | 1003286105 |
---|---|
Provider Name | Kathryn Green |
First Address | Sound Beach, NY 11789-2534 |
Second Address | Sound Beach, NY 11789-2534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2015 |
Last Update Date | 01/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0717371-1 | NYS (01) | NY |