Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 008883-1 | NY |
N | 2251H1300X | Human Factors | 008883-1 | NY |
N | 225XH1300X | Human Factors | 008883-1 | NY |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 008883-1 | NY |
N | 225XP0200X | Occupational Therapist - Pediatrics | 008883-1 | NY |
NPI | 1255431730 |
---|---|
Provider Name | Mr. Mark Alan Rutledge |
First Address | Watertown, NY 13601-5137 |
Second Address | Watertown, NY 13601-5137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P98002 | (02) | NY |