Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 46TR00218300 | NJ |
NPI | 1023324225 |
---|---|
Provider Name | Michelle Joy Davis-Korngut |
First Address | Lawrenceville, NJ 08648-1542 |
Second Address | Lawrenceville, NJ 08648-1542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2010 |
Last Update Date | 25/08/2010 |