Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 010943-01 | NY |
NPI | 1023762341 |
---|---|
Provider Name | Rebekah Leigh Walter |
First Address | Grand Island, NY 14072-2249 |
Second Address | Grand Island, NY 14072-2249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2022 |
Last Update Date | 06/02/2022 |