Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | P93224 | NY |
NPI | 1013321488 |
---|---|
Provider Name | Megan Overlan |
First Address | Kenmore, NY 14217-1040 |
Second Address | Kenmore, NY 14217-1040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2014 |
Last Update Date | 13/06/2014 |