Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0-12891-1 | NY |
NPI | 1033354436 |
---|---|
Provider Name | Mrs. Anu Samuel |
First Address | Queens Village, NY 11427-2514 |
Second Address | Queens Village, NY 11427-2514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2008 |
Last Update Date | 13/12/2008 |