Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 007771-1 | NY |
NPI | 1053566596 |
---|---|
Provider Name | Ms. Rebecca Lynne Renaud |
First Address | Brooklyn, NY 11225-5008 |
Second Address | Brooklyn, NY 11225-5008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2008 |
Last Update Date | 25/11/2008 |