Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003560848 |
---|---|
Provider Name | Keiani Garcia Santos Gomes |
First Address | Dorchester, MA 02122-1875 |
Second Address | Dorchester, MA 02122-3518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2022 |
Last Update Date | 10/02/2022 |