Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 46TR00688100 | NJ |
NPI | 1124509039 |
---|---|
Provider Name | Pearl Villanueva |
First Address | Cherry Hill, NJ 08034-3334 |
Second Address | Cherry Hill, NJ 08034-3334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2018 |
Last Update Date | 28/08/2018 |