Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 013758 | NY |
NPI | 1134419898 |
---|---|
Provider Name | Miroslava Montesdeoca |
First Address | Bronx, NY 10457-1526 |
Second Address | Bronx, NY 10457-1526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2011 |
Last Update Date | 15/04/2011 |