Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OC-006525-L | PA |
NPI | 1639590458 |
---|---|
Provider Name | Mary Schmidt |
First Address | Wyndmoor, PA 19038-7519 |
Second Address | Wyndmoor, PA 19038-7519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2013 |
Last Update Date | 20/12/2013 |