Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 007507 | NY |
NPI | 1003174558 |
---|---|
Provider Name | Nicolette Alecia, Roxanne Carney |
First Address | Hollis, NY 11423-3101 |
Second Address | Hollis, NY 11423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2012 |
Last Update Date | 02/05/2012 |