Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 008416-1 | NY |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 008416-1 | NY |
N | 225XP0200X | Occupational Therapist - Pediatrics | 46TR00301300 | NJ |
NPI | 1013285931 |
---|---|
Provider Name | Mrs. Melissa Dana Levine |
First Address | Rivervale, NJ 07675-6164 |
Second Address | Rivervale, NJ 07675-6164 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2011 |
Last Update Date | 06/12/2011 |