Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 005969-1 | NY |
NPI | 1003239682 |
---|---|
Provider Name | Ms. Eileen Dwyre |
First Address | Warwick, NY 10990-3559 |
Second Address | New York, NY 10001-3816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2014 |
Last Update Date | 02/02/2014 |