Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 46TR00794600 | NJ |
NPI | 1518500248 |
---|---|
Provider Name | Lia Levine |
First Address | Morganville, NJ 07751-4301 |
Second Address | Morganville, NJ 07751-4301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2019 |
Last Update Date | 25/10/2019 |