Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0038091 | NY |
NPI | 1003919614 |
---|---|
Provider Name | Mrs. Robin Renae Goss |
First Address | Voorheesville, NY 12186-9545 |
Second Address | Latham, NY 12110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 25/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03173131 | (05) | NY |