Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 003324 | NY |
NPI | 1003832106 |
---|---|
Provider Name | Lisa Henderson |
First Address | White Plains, NY 10601-4803 |
Second Address | White Plains, NY 10601-4803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |