Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 46TA09205600 | NJ |
NPI | 1073190575 |
---|---|
Provider Name | Madison Elizabeth Peters |
First Address | Little Falls, NJ 07424-1711 |
Second Address | Little Falls, NJ 07424-1733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2021 |
Last Update Date | 29/03/2021 |