Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119007696 | VA |
NPI | 1003397167 |
---|---|
Provider Name | Megan Mottola |
First Address | Ballston Spa, NY 12020-1041 |
Second Address | Petersburg, VA 23805-9117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2018 |
Last Update Date | 27/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80026512304 | MVP HEALTHCARE (01) | NY |