Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP007131 | PA |
NPI | 1013291236 |
---|---|
Provider Name | Miss Ashley Lynn Perigo |
First Address | Mount Wolf, PA 17347-9637 |
Second Address | Mount Wolf, PA 17347-9637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2011 |
Last Update Date | 06/10/2011 |