Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 018053 | NY |
NPI | 1275049355 |
---|---|
Provider Name | Vaughn Charles Adlam |
First Address | Jamaica, NY 11432-5517 |
Second Address | Valley Stream, NY 11581-1773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2017 |
Last Update Date | 27/12/2017 |