Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 001154 | CT |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 001154 | CT |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 001154 | CT |
NPI | 1952682114 |
---|---|
Provider Name | Mrs. Julie Margaret Fasolino |
First Address | Poughkeepsie, NY 12603-6329 |
Second Address | Bethel, CT 06801-1043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2011 |
Last Update Date | 01/09/2011 |