Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1346859576 |
---|---|
Provider Name | Ophelia Darko |
First Address | Worcester, MA 01603-2207 |
Second Address | Worcester, MA 01608-1553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2020 |
Last Update Date | 25/09/2020 |