Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 012505-1 | NY |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 012505-1 | NY |
N | 225XP0200X | Occupational Therapist - Pediatrics | 012505-1 | NY |
NPI | 1487718300 |
---|---|
Provider Name | Mr. Darrell James Whitbeck |
First Address | Rochester, NY 14623-4532 |
Second Address | Canandaigua, NY 14424-7964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 10/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01635592 | (05) | NY |