Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 0099551 | NY |
NPI | 1154613883 |
---|---|
Provider Name | Ms. Jacqueline Elizabeth Trotman |
First Address | Cambria Heights, NY 11411-2116 |
Second Address | Cambria Heights, NY 11411-2116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2011 |
Last Update Date | 13/05/2011 |