Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 32002418A | IN |
NPI | 1023454436 |
---|---|
Provider Name | Samantha Marie Maschino |
First Address | Caro, MI 48723-9200 |
Second Address | Caro, MI 48723-9200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2013 |
Last Update Date | 14/05/2013 |