Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OC011604 | PA |
NPI | 1821406059 |
---|---|
Provider Name | Miss Anjana Menon |
First Address | Bridgeville, PA 15017-1558 |
Second Address | Bridgeville, PA 15017-1558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2014 |
Last Update Date | 31/07/2014 |