Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 0P001615L | PA |
NPI | 1003099987 |
---|---|
Provider Name | Teronna Bosserman |
First Address | Mechanicsburg, PA 17055-5701 |
Second Address | Heathrow, FL 32746-5303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2007 |
Last Update Date | 13/12/2007 |