Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | ||
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1154730810 |
---|---|
Provider Name | Mark Goren |
First Address | Philadelphia, PA 19103 |
Second Address | Philadelphia, PA 19103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2014 |
Last Update Date | 07/08/2014 |