Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 014812 | NY |
NPI | 1023329356 |
---|---|
Provider Name | Kristine Lalicon Costes |
First Address | New York, NY 10002-3207 |
Second Address | New York, NY 10002-3207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 01/07/2010 |