Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 011645-1 | NY |
NPI | 1104057249 |
---|---|
Provider Name | Laura C. Koralewski |
First Address | Big Flats, NY 14814-9601 |
Second Address | Big Flats, NY 14814-9601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 13/09/2010 |