Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 006378-1 | NY |
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 006378-1 | NY |
NPI | 1487063582 |
---|---|
Provider Name | Mrs. Ellen Rusyniak |
First Address | Homer, NY 13077-8710 |
Second Address | New Woodstock, NY 13122-9729 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2014 |
Last Update Date | 04/08/2014 |