Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 004281-1 | NY |
N | 225XG0600X | Occupational Therapist - Gerontology | 004281-1 | NY |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 004281-1 | NY |
N | 225XP0200X | Occupational Therapist - Pediatrics | 004281-1 | NY |
NPI | 1558749556 |
---|---|
Provider Name | Mrs. Patricia Alice Anderson |
First Address | Greenville, NY 12083-2130 |
Second Address | Greenville, NY 12083-2130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2015 |
Last Update Date | 11/05/2015 |