Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 003226-1 | NY |
NPI | 1023179595 |
---|---|
Provider Name | Marly Donna Brice |
First Address | Henryville, PA 18332-1712 |
Second Address | New York, NY 10031-4108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |