Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 010614 | NY |
NPI | 1003428277 |
---|---|
Provider Name | Miss Kylie Rose Wilkins |
First Address | Kenmore, NY 14217-2936 |
Second Address | Lewiston, NY 14092-1942 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2020 |
Last Update Date | 03/11/2020 |