Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 009909-1 | NY |
NPI | 1003051293 |
---|---|
Provider Name | Melanie S Bush |
First Address | Beaver Falls, NY 13305-0192 |
Second Address | Castorland, NY 13620-0192 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2008 |
Last Update Date | 03/12/2008 |