Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 007611-1 | NY |
N | 225700000X | Massage Therapist | 021696-1 | NY |
NPI | 1013238104 |
---|---|
Provider Name | Marissa Nicole Woodley |
First Address | New Rochelle, NY 10801-2009 |
Second Address | New Rochelle, NY 10801-2009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2010 |
Last Update Date | 28/02/2017 |