Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 014417-1 | NY |
NPI | 1023143781 |
---|---|
Provider Name | Ronni Marangoni |
First Address | Coram, NY 11727-3132 |
Second Address | Port Jefferson, NY 11777-1928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |