Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT01133 | RI |
Y | 225XG0600X | Occupational Therapist - Gerontology | 003747 | CT |
NPI | 1487908828 |
---|---|
Provider Name | Miss Mary Lynn Sciarillo |
First Address | Bradford, RI 02808-1334 |
Second Address | Bradford, RI 02808-1334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2012 |
Last Update Date | 07/11/2012 |