Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 010042 | NY |
NPI | 1073827002 |
---|---|
Provider Name | Ms. Camille Ann Roldan |
First Address | Old Bethpage, NY 11804-1241 |
Second Address | Old Bethpage, NY 11804-1241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2010 |
Last Update Date | 02/08/2010 |