Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 006798-1 | NY |
NPI | 1003850652 |
---|---|
Provider Name | Ms. Katherine Janice Bufano |
First Address | Syracuse, NY 13215-9709 |
Second Address | Syracuse, NY 13210-2716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010792 | LICENSE (01) | NY |
998996 | NATIONAL BOARD CERTIFICAT (01) |