Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 010232-1 | NY |
N | 225XE0001X | Environmental Modification | ||
N | 225XM0800X | Mental Health |
NPI | 1528191863 |
---|---|
Provider Name | Ms. Edith M Depeyster |
First Address | Clinton, NY 13323-1102 |
Second Address | Sauquoit, NY 13456-2010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 17/03/2017 |