Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 009612-1 | NY |
NPI | 1003318361 |
---|---|
Provider Name | Lauren Wise |
First Address | Middletown, NY 10940-6681 |
Second Address | Slate Hill, NY 10973-3713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2018 |
Last Update Date | 02/03/2018 |