Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1265781421 |
---|---|
Provider Name | Samantha Bisnott |
First Address | Valley Stream, NY 11580-6042 |
Second Address | Roosevelt Island, NY 10044-0052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2012 |
Last Update Date | 04/09/2012 |