Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 012355-1 | NY |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 012355-1 | NY |
N | 225XP0200X | Occupational Therapist - Pediatrics | 012355-1 | NY |
NPI | 1093870933 |
---|---|
Provider Name | Ms. Nicole L Dillon |
First Address | Canandaigua, NY 14424-1104 |
Second Address | Canandaigua, NY 14424-7964 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 22/08/2016 |