Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 009380-1 | NY |
NPI | 1013443332 |
---|---|
Provider Name | Paula Sue Liucci |
First Address | Victor, NY 14564-9744 |
Second Address | Victor, NY 14564-9744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2017 |
Last Update Date | 21/02/2020 |