Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 010386-01 | NY |
NPI | 1013548478 |
---|---|
Provider Name | Nicole Ellis |
First Address | Bellmore, NY 11710 |
Second Address | Bellmore, NY 11710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2020 |
Last Update Date | 03/02/2020 |