Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 007725 | NY |
NPI | 1073784385 |
---|---|
Provider Name | Ms. Laura Anne O'shea |
First Address | Bayport, NY 11705-2137 |
Second Address | Bayport, NY 11705-2137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2008 |
Last Update Date | 13/03/2008 |