Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 011712-01 |
NPI | 1861063521 |
---|---|
Provider Name | Mrs. Amy Elizabeth Smith |
First Address | Spencerport, NY 14559-2215 |
Second Address | Rochester, NY 14621-3065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2021 |
Last Update Date | 05/07/2021 |