Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 02543401 | NY |
NPI | 1396330239 |
---|---|
Provider Name | Kyla Ruth Bartnicki |
First Address | Clifton Park, NY 12065-6149 |
Second Address | Albany, NY 12208-3412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2021 |
Last Update Date | 03/03/2021 |