Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 007187-1 | NY |
NPI | 1003112624 |
---|---|
Provider Name | Mrs. Amy Jo Bellomy |
First Address | Guilderland, NY 12084-9547 |
Second Address | Guilderland, NY 12084-9547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2011 |
Last Update Date | 28/01/2011 |