Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 46TAO9039600 | NJ |
NPI | 1003054883 |
---|---|
Provider Name | Peter John Owsianik |
First Address | Lincroft, NJ 07738-1407 |
Second Address | Lincroft, NJ 07738-1407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2009 |
Last Update Date | 01/02/2009 |