Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 46TR00016200 | NJ |
NPI | 1003112590 |
---|---|
Provider Name | Mr. Gregg P Taylor |
First Address | Freehold, NJ 07728-7879 |
Second Address | Freehold, NJ 07728-7879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2011 |
Last Update Date | 01/02/2011 |