Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1013300748 |
---|---|
Provider Name | Miss Chola Cayanan |
First Address | Queens Village, NY 11428-1718 |
Second Address | Queens Village, NY 11428-1718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2015 |
Last Update Date | 09/06/2016 |