Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 011498-1 | NY |
NPI | 1003952433 |
---|---|
Provider Name | Ms. Jennifer Ann Mancuso |
First Address | East Meadow, NY 11554-3523 |
Second Address | Carle Place, NY 11514-1741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |