Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 022983 | NY |
NPI | 1073089736 |
---|---|
Provider Name | Marissa Annette Colombo |
First Address | Staten Island, NY 10309-4277 |
Second Address | Staten Island, NY 10310-1906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2018 |
Last Update Date | 22/10/2018 |