Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC005914L | PA |
N | 225XH1200X | Occupational Therapist - Hand |
NPI | 1164404752 |
---|---|
Provider Name | Linda M Salas-Mamary |
First Address | Tobyhanna, PA 18466-8985 |
Second Address | Tobyhanna, PA 18466-8985 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 17/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0325890000 | BLUE SHIELD (01) | PA |
2101568 | AETNA (01) | PA |
35365 | BLUE SHIELD (01) | PA |
50017331 | CAPITAL BLUE CROSS (01) | PA |
807285 | FIRST PRIORITY (01) | PA |