Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT-001887 | OH |
NPI | 1114110095 |
---|---|
Provider Name | Marlita Divencenzo |
First Address | Grafton, OH 44044-1263 |
Second Address | Sandusky, OH 44870-7161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2007 |
Last Update Date | 23/08/2007 |