Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 012898-1 | NY |
NPI | 1003440611 |
---|---|
Provider Name | Mrs. Jill Christine Whitbeck |
First Address | Canandaigua, NY 14424-7964 |
Second Address | Canandaigua, NY 14424-7964 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2020 |
Last Update Date | 24/02/2020 |