Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 102134-01 | NY |
NPI | 1336796580 |
---|---|
Provider Name | Miss Kathryn Grace Tietz |
First Address | Delhi, NY 13753-1048 |
Second Address | Oneonta, NY 13820-2629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2019 |
Last Update Date | 22/08/2019 |