Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 021316-1 | NY |
NPI | 1043742182 |
---|---|
Provider Name | Tara Hanley |
First Address | Brewster, NY 10509-3014 |
Second Address | New York, NY 10017-5704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2017 |
Last Update Date | 29/03/2017 |