Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XM0800X | Mental Health | ||
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1407156888 |
---|---|
Provider Name | Tracey Laine Demaria |
First Address | Easton, PA 18045-8036 |
Second Address | Easton, PA 18045-8036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2010 |
Last Update Date | 01/11/2010 |