Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225CX0006X | Orientation and Mobility Training Provider | 001112 | NY |
NPI | 1316157910 |
---|---|
Provider Name | Nicole Gathers |
First Address | Brooklyn, NY 11218-2947 |
Second Address | Brooklyn, NY 11203-2097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |