Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 006848-1 | NY |
NPI | 1013527894 |
---|---|
Provider Name | Millie S Mogouong |
First Address | Newark, NJ 07105-3705 |
Second Address | Newark, NJ 07105-3705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2020 |
Last Update Date | 05/08/2020 |