Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 008207-1 | NY |
NPI | 1023261054 |
---|---|
Provider Name | Miss Virginia O'brien |
First Address | Rockaway Park, NY 11694 |
Second Address | Rockaway Park, NY 11694-2867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2008 |
Last Update Date | 04/11/2008 |