| NPI | 1710111091 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 252Y00000X Early Intervention Provider Agency | |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2009-05-14 |