Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | 391-5 | NJ |
NPI | 1023464773 |
---|---|
Provider Name | Rebecca Macey |
First Address | Riverdale, NJ 07457-1715 |
Second Address | Riverdale, NJ 07457-1715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2016 |
Last Update Date | 12/05/2016 |