Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 46TR00453400 | NJ |
NPI | 1023325677 |
---|---|
Provider Name | Ms. Juliane Christina Gardner |
First Address | Chestnut Ridge, NY 10977-6620 |
Second Address | Lyndhurst, NJ 07071-3621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2010 |
Last Update Date | 02/09/2010 |