Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 008964-1 | NY |
NPI | 1063669737 |
---|---|
Provider Name | Mary Danieu |
First Address | Syracuse, NY 13219-1723 |
Second Address | Syracuse, NY 13219-1723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2008 |
Last Update Date | 25/08/2008 |