Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | TOP008363 | PA |
NPI | 1023395357 |
---|---|
Provider Name | Samantha Jo Kozlosky |
First Address | Pottsville, PA 17901-3945 |
Second Address | Pottsville, PA 17901-3862 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2011 |
Last Update Date | 05/02/2015 |