Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 012752-1 | NY |
NPI | 1053628420 |
---|---|
Provider Name | Mrs. Kimberly Benedetto |
First Address | Barneveld, NY 13304-2500 |
Second Address | Barneveld, NY 13304-2500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2010 |
Last Update Date | 08/09/2010 |