Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 016381-1 | NY |
NPI | 1003126145 |
---|---|
Provider Name | Tashawna Ferguson |
First Address | Lithonia, GA 30058 |
Second Address | Staten Island, NY 10308-2742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2010 |
Last Update Date | 07/10/2010 |