Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 006042-1 | NY |
NPI | 1003187857 |
---|---|
Provider Name | Ms. Bernadette Marie Timko |
First Address | Farmingdale, NY 11735-3643 |
Second Address | Port Jefferson Station, NY 11776-2053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2012 |
Last Update Date | 24/01/2012 |