Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 00874801 | NY |
NPI | 1023760907 |
---|---|
Provider Name | Roscelin Yisleni Mendoza Savinon |
First Address | Flushing, NY 11367-1241 |
Second Address | Brooklyn, NY 11206-2580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2022 |
Last Update Date | 22/01/2022 |