Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 002762-1 | NY |
NPI | 1285272658 |
---|---|
Provider Name | Ms. Patricia Rachel Vallon |
First Address | Montebello, NY 10901-3809 |
Second Address | Montebello, NY 10901-3809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2019 |
Last Update Date | 17/12/2019 |