Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 003342 | NY |
NPI | 1003952474 |
---|---|
Provider Name | Pamela Gordon |
First Address | Long Island City, NY 11106-4304 |
Second Address | Glen Head, NY 11545-2641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |