Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1023557584 |
---|---|
Provider Name | Ms. Kristen R Whitley |
First Address | Bayside, NY 11361-1406 |
Second Address | Fresh Meadows, NY 11365-1140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2017 |
Last Update Date | 16/02/2017 |