Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | NY |
NPI | 1053077065 |
---|---|
Provider Name | Mary Blackley |
First Address | Kenmore, NY 14217-1040 |
Second Address | Kenmore, NY 14217-1040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2021 |
Last Update Date | 14/11/2021 |