Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 015365-1 | NY |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 015365-1 | NY |
NPI | 1699272401 |
---|---|
Provider Name | Kristy Gulotta |
First Address | Syosset, NY 11791-4515 |
Second Address | Syosset, NY 11791-4515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2018 |
Last Update Date | 26/08/2019 |