Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP001949L | PA |
NPI | 1003372335 |
---|---|
Provider Name | Mary Lynne Bugay |
First Address | Imperial, PA 15126-1305 |
Second Address | Coraopolis, PA 15108-2349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2019 |
Last Update Date | 12/02/2019 |