Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 009994 | NY |
NPI | 1013473750 |
---|---|
Provider Name | Nadine Marie Faughnan |
First Address | Pearl River, NY 10965-1633 |
Second Address | Yonkers, NY 10701-4004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2019 |
Last Update Date | 19/02/2019 |