Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 001486-1 | NY |
NPI | 1033355409 |
---|---|
Provider Name | Mrs. Susan Marie Parker |
First Address | Lockport, NY 14051 |
Second Address | East Amherst, NY 14051-1017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2009 |
Last Update Date | 06/01/2009 |