Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 001269-1 | NY |
NPI | 1013298561 |
---|---|
Provider Name | Mrs. Eileen Madonna Stayzer |
First Address | Eden, NY 14057 |
Second Address | Eden, NY 14057-1130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2011 |
Last Update Date | 26/09/2011 |