Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 006413-1 | NY |
NPI | 1023247665 |
---|---|
Provider Name | Mrs. Loretta England |
First Address | Freeport, NY 11520-4464 |
Second Address | Freeport, NY 11520-4464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2009 |
Last Update Date | 02/07/2009 |