Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 002446-1 | NY |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 002446-1 | NY |
NPI | 1720391444 |
---|---|
Provider Name | Ms. Geraldine Legeorgia Mowatt |
First Address | Valley Stream, NY 11580-1941 |
Second Address | Valley Stream, NY 11580-1941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2010 |
Last Update Date | 22/07/2010 |