Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | CL1008937 | OH |
NPI | 1083068365 |
---|---|
Provider Name | Robertta Thoryk |
First Address | Newbury, OH 44065-9126 |
Second Address | Newbury, OH 44065-9126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2016 |
Last Update Date | 22/04/2016 |