Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 46TR005440400 | NJ |
NPI | 1225335540 |
---|---|
Provider Name | Mrs. Mary Katherine Reilly |
First Address | Westfield, NJ 07090-3337 |
Second Address | Westfield, NJ 07090-4763 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2011 |
Last Update Date | 23/02/2011 |