Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 020103-1 | NY |
NPI | 1003371758 |
---|---|
Provider Name | Kizzie Whyte |
First Address | Brooklyn, NY 11203-4936 |
Second Address | Brooklyn, NY 11204-2744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2019 |
Last Update Date | 06/02/2019 |