Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 015341 | NY |
NPI | 1013556406 |
---|---|
Provider Name | Mr. Troy Edward Canada |
First Address | Plattsburgh, NY 12901-1427 |
Second Address | Plattsburgh, NY 12901-1427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2020 |
Last Update Date | 02/01/2020 |