Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 008875-1 | NY |
NPI | 1023478377 |
---|---|
Provider Name | Mr. Tyronne Cabrera-Nickie |
First Address | Brooklyn, NY 11238-6058 |
Second Address | Forest Hills, NY 11375-1022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/02/2016 |
Last Update Date | 29/02/2016 |