Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 013553-1 | NY |
NPI | 1003056326 |
---|---|
Provider Name | Mrs. Kathryn Moore |
First Address | Hilton, NY 14468-8942 |
Second Address | Hilton, NY 14468-8942 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2009 |
Last Update Date | 26/02/2009 |