Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
Y | 225X00000X | Occupational Therapist | 024706 | NY |
NPI | 1003445388 |
---|---|
Provider Name | Kristen Connors |
First Address | Clifton Park, NY 12065-1645 |
Second Address | Clifton Park, NY 12065-1645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2020 |
Last Update Date | 23/04/2020 |