Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 023405 | NY |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 023405 | NY |
NPI | 1023675774 |
---|---|
Provider Name | Leah Rose Dugrenier |
First Address | Ballston Spa, NY 12020-1734 |
Second Address | Glens Falls, NY 12801-4422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2019 |
Last Update Date | 03/03/2021 |