Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT011378 | OH |
NPI | 1003493941 |
---|---|
Provider Name | Lucia C Congeni |
First Address | Middlefield, OH 44062-0987 |
Second Address | Middlefield, OH 44062-9661 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2021 |
Last Update Date | 26/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT011378 | STATE BOARD LICENSE NUMBER (01) | OH |