Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1023577715 |
---|---|
Provider Name | Kristine Moran |
First Address | Kerhonkson, NY 12446-1203 |
Second Address | Purchase, NY 10577-2554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2019 |
Last Update Date | 13/03/2019 |