Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 14860-1 | NY |
NPI | 1003181629 |
---|---|
Provider Name | Sallyann Mangano |
First Address | Belle Harbor, NY 11694-1308 |
Second Address | Belle Harbor, NY 11694-1308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2012 |
Last Update Date | 14/03/2012 |