Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 0101161 | NY |
NPI | 1548415391 |
---|---|
Provider Name | Ms. Lisa C Bruno |
First Address | Bedford Hills, NY 10507 |
Second Address | Bedford Hills, NY 10507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2008 |
Last Update Date | 20/11/2008 |