Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 46TR001541 | NJ |
NPI | 1114967213 |
---|---|
Provider Name | Ms. Virginia Vitale |
First Address | Wayne, NJ 07470-5823 |
Second Address | Wayne, NJ 07470-5823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |