Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 012739-1 | NY |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 012739-1 | NY |
N | 225XP0200X | Occupational Therapist - Pediatrics | 012739-1 | NY |
NPI | 1316192164 |
---|---|
Provider Name | Ms. Sally Schutta |
First Address | Malverne, NY 11565-1714 |
Second Address | Malverne, NY 11565-1714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2008 |
Last Update Date | 20/11/2008 |