Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 008749-1 | NY |
NPI | 1023567922 |
---|---|
Provider Name | Lauren Cummings |
First Address | Whitehall, NY 12887-3633 |
Second Address | Whitehall, NY 12887-3633 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2016 |
Last Update Date | 03/10/2016 |