Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OC006788-L | PA |
Y | 225XH1200X | Occupational Therapist - Hand | 1051100607 | PA |
NPI | 1093774200 |
---|---|
Provider Name | Mrs. Suzanne Smith Brandley |
First Address | Woolwich, NJ 08085 |
Second Address | Philadelphia, PA 19123-3230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 26/03/2014 |