Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 007080-1 | NY |
NPI | 1003071481 |
---|---|
Provider Name | Mr. Robert G. Wiechec |
First Address | North Tonawanda, NY 14120-1703 |
Second Address | North Tonawanda, NY 14120-1703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2008 |
Last Update Date | 23/08/2010 |