Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 012030-1 | NY |
NPI | 1023362498 |
---|---|
Provider Name | Mrs. Jennifer Louise Eveleigh |
First Address | Victor, NY 14564-1168 |
Second Address | Victor, NY 14564-1168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2012 |
Last Update Date | 06/11/2012 |