Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 46TR00046400 | NJ |
NPI | 1285680868 |
---|---|
Provider Name | Mary B Wesley |
First Address | Ronkonkoma, NY 11779-7639 |
Second Address | Freehold, NJ 07728-4832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 10/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
094832PYA | (02) | NJ |