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1215281795
JACOB THADISSERIL
BRONX, NY
NPI
1215281795
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225X00000X Occupational Therapist
(Licence: NY 017449)
Enumeration Date
2012-11-05
Last Update Date
2012-11-05
Business Address
-- JACOB THADISSERIL
2237 ELLIS AVE
BRONX, NY 10462-5105
Phone number: 212-221-1544
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Mailing Address
-- JACOB THADISSERIL
2237 ELLIS AVE
BRONX, NY 10462-5105
Phone number:
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