Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 008081 | NY |
NPI | 1003177148 |
---|---|
Provider Name | Nadejda Manolov |
First Address | Lakewood, NJ 08701-5288 |
Second Address | Brooklyn, NY 11236-4001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2012 |
Last Update Date | 05/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
305532NAMA | (05) | NY |