Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 009077 | NY |
NPI | 1003265620 |
---|---|
Provider Name | Mark Guzman |
First Address | Kings Park, NY 11754-4418 |
Second Address | Kings Park, NY 11754-4418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2016 |
Last Update Date | 04/06/2016 |