Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation |
NPI | 1366777476 |
---|---|
Provider Name | Nicole Shawna Manolescu |
First Address | New York Mills, NY 13417-1216 |
Second Address | Syracuse, NY 13219-3009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2009 |
Last Update Date | 07/10/2009 |