Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 001402 | CT |
NPI | 1003887472 |
---|---|
Provider Name | Nooran Scully |
First Address | Chadds Ford, PA 19317-9721 |
Second Address | Newington, CT 06111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 28/05/2013 |