Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 008665-1 | NY |
NPI | 1003220609 |
---|---|
Provider Name | Mrs. Stephanie Malone |
First Address | Penfield, NY 14526-2329 |
Second Address | Penfield, NY 14526-2333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2014 |
Last Update Date | 12/06/2014 |