Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 46TR00426800 | NJ |
NPI | 1003000647 |
---|---|
Provider Name | Ms. Nicole Marie Lepore |
First Address | Madison, NJ 07940-2317 |
Second Address | Madison, NJ 07940-2317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 01/03/2013 |