Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 004481-1 | NY |
NPI | 1003217415 |
---|---|
Provider Name | Megan Anna Kelly |
First Address | Albany, NY 12208-1906 |
Second Address | Albany, NY 12208-3412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2014 |
Last Update Date | 05/09/2014 |