Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 009470-1 | NY |
NPI | 1003052630 |
---|---|
Provider Name | Mrs. Adina Tyberg |
First Address | Brooklyn, NY 11230-5162 |
Second Address | Brooklyn, NY 11230-5162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2009 |
Last Update Date | 03/01/2009 |