Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 003803-1 | NY |
NPI | 1023339439 |
---|---|
Provider Name | Mrs. Ellen I Taylor |
First Address | Bergen, NY 14416-9573 |
Second Address | Bergen, NY 14416-9573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2010 |
Last Update Date | 21/06/2010 |