Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 017961-1 | NY |
NPI | 1053745349 |
---|---|
Provider Name | Stacy Brooke Schwartz |
First Address | Jericho, NY 11753-1829 |
Second Address | Jericho, NY 11753-1829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2013 |
Last Update Date | 05/11/2015 |