Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 024088 | NY |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 46TR00903200 | NJ |
N | 225XP0200X | Occupational Therapist - Pediatrics | 024088 | NY |
NPI | 1124660493 |
---|---|
Provider Name | Ms. Victoria Ann Walters |
First Address | Suffern, NY 10901-7839 |
Second Address | Hastings On Hudson, NY 10706-3801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2019 |
Last Update Date | 10/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
46TR00903200 | NJ OFFICE OF CONSUMER AFFAIRS (01) | NJ |