Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 023620-1 | NY |
NPI | 1154979391 |
---|---|
Provider Name | Kimberly Diana Rosales |
First Address | Ozone Park, NY 11416-1615 |
Second Address | Richmond Hill, NY 11418-2013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2019 |
Last Update Date | 30/08/2019 |