Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 012574-1 | NY |
NPI | 1003061102 |
---|---|
Provider Name | Mrs. Criselda Jose |
First Address | Highland Mills, NY 10930-8316 |
Second Address | Bronx, NY 10453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2008 |
Last Update Date | 14/03/2013 |