Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 004733 | NY |
NPI | 1053667006 |
---|---|
Provider Name | Ms. Christine D. Momich |
First Address | Bayside, NY 11361-2236 |
Second Address | Rego Park, NY 11374-1741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2012 |
Last Update Date | 27/07/2012 |