Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1831455336 |
---|---|
Provider Name | Natalia Chernyshova |
First Address | Philadelphia, PA 19116-1947 |
Second Address | Philadelphia, PA 19116-1947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 09/04/2012 |