Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 008325-1 | NY |
NPI | 1003240870 |
---|---|
Provider Name | Ms. Ashley N Bantin |
First Address | Dunkirk, NY 14048-2720 |
Second Address | Dunkirk, NY 14048-2720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2013 |
Last Update Date | 28/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008325-1 | NY STATE (01) | NY |