Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | P81730 | NY |
NPI | 1003199241 |
---|---|
Provider Name | Mandy Lee Stuart |
First Address | Ardsley, NY 10502-1106 |
Second Address | Ardsley, NY 10502-1106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2011 |
Last Update Date | 23/09/2011 |