Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1417411034 |
---|---|
Provider Name | Margaret Passalaqua |
First Address | Greenbrier, AR 72058-8908 |
Second Address | Conway, AR 72034-6993 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2019 |
Last Update Date | 28/01/2019 |