Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OC003215L | NY |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4173 | SC |
NPI | 1225351307 |
---|---|
Provider Name | Rita Roberts |
First Address | Cortland, NY 13045-2906 |
Second Address | Sumter, SC 29150-4949 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2010 |
Last Update Date | 23/04/2014 |