Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 005689 | NY |
NPI | 1023318490 |
---|---|
Provider Name | Mrs. Kimberlee Phillips |
First Address | Glens Falls, NY 12801-2724 |
Second Address | Glens Falls, NY 12801-2931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2010 |
Last Update Date | 01/11/2010 |