Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 025096 | NY |
NPI | 1003416314 |
---|---|
Provider Name | Ms. Kimberly Ann Couse |
First Address | Rochester, NY 14624-1348 |
Second Address | Irondequoit, NY 14609-2810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2020 |
Last Update Date | 27/10/2020 |