Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 024593 | NY |
NPI | 1104414663 |
---|---|
Provider Name | Mrs. Nicole Leone |
First Address | Valley Stream, NY 11580-2449 |
Second Address | Valley Stream, NY 11580-2449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2021 |
Last Update Date | 08/01/2021 |