Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 017004 | NY |
NPI | 1003462094 |
---|---|
Provider Name | Mrs. Amanda M Morton |
First Address | Jamestown, NY 14701-2724 |
Second Address | Kenmore, NY 14217-1040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2019 |
Last Update Date | 14/08/2019 |