Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 63 008030 | NY |
NPI | 1003199530 |
---|---|
Provider Name | Lorrie Clute |
First Address | Fayetteville, NY 13066-1237 |
Second Address | East Syracuse, NY 13057-1800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2011 |
Last Update Date | 21/09/2011 |