Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 007803 | NY |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 007803 | NY |
NPI | 1013226075 |
---|---|
Provider Name | Ms. Electra Petra |
First Address | Astoria, NY 11103 |
Second Address | New York, NY 10034-1655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2010 |
Last Update Date | 24/09/2010 |