Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC000719L | PA |
NPI | 1003080912 |
---|---|
Provider Name | Sandra Masayko |
First Address | Phila, PA 19151-2414 |
Second Address | Phila, PA 19151-2414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 19/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1021218120001 | (05) | PA |