Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 015493-1 | NY |
N | 225XP0200X | Occupational Therapist - Pediatrics | 015493-1 | NY |
NPI | 1346473253 |
---|---|
Provider Name | Ms. Polina Starr |
First Address | Rego Park, NY 11374-4624 |
Second Address | Richmond Hill, NY 11418-3443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2009 |
Last Update Date | 13/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03182285 | (05) | NY |