Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 46TR00766600 | NJ |
NPI | 1003903451 |
---|---|
Provider Name | Ms. Connie Wah Tam |
First Address | Westfield, NJ 07090-1346 |
Second Address | New York, NY 10002-7537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 18/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008593 | NYS LICENSE# (01) | NY |
46TR00766600 | NJ LICENSE # (01) | NJ |