Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | NY |
NPI | 1003193269 |
---|---|
Provider Name | Mrs. Darlene Carol Dylag |
First Address | Corfu, NY 14036-9640 |
Second Address | Corfu, NY 14036-9640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2011 |
Last Update Date | 15/11/2011 |