Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 016413-1 | NY |
N | 225XM0800X | Mental Health | 016413-1 | NY |
NPI | 1437423811 |
---|---|
Provider Name | Stephen Nawotniak |
First Address | Lancaster, NY 14086-1525 |
Second Address | Lancaster, NY 14086-1525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2012 |
Last Update Date | 18/04/2020 |