Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 016619-1 | NY |
NPI | 1154886273 |
---|---|
Provider Name | Trina Lynn Haver |
First Address | Clifton Park, NY 12065-6752 |
Second Address | Clifton Park, NY 12065-2951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2019 |
Last Update Date | 02/02/2019 |