Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1184162679 |
---|---|
Provider Name | Mrs. Morgan Patino |
First Address | Cherry Hill, NJ 08003-1000 |
Second Address | Wilmington, DE 19803-3733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2017 |
Last Update Date | 06/02/2017 |