Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 003054 | NY |
NPI | 1104070580 |
---|---|
Provider Name | Mrs. Robyn Renee Sturdevant |
First Address | Durhamville, NY 13054-3111 |
Second Address | Oswego, NY 13126-2045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2008 |
Last Update Date | 11/11/2008 |