Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 640022131 | NY |
NPI | 1003216615 |
---|---|
Provider Name | Mrs. Colleen Patricia Reilly |
First Address | Newburgh, NY 12550-5540 |
Second Address | Newburgh, NY 12550-5540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2014 |
Last Update Date | 02/09/2014 |