Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 46TR00366300 | NJ |
NPI | 1346367703 |
---|---|
Provider Name | Ms. Mary T Shea |
First Address | Hoboken, NJ 07030-1916 |
Second Address | West Orange, NJ 07052-1424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |