Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 46TA09189100 | NJ |
NPI | 1023645066 |
---|---|
Provider Name | Renee Coretta Scott |
First Address | West Orange, NJ 07052-4828 |
Second Address | West Orange, NJ 07052-4828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2020 |
Last Update Date | 26/03/2020 |