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Individual
JOHAN HALLSTROM
Active
Individual
JOHAN HALLSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S OT
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
0206941
NY
225X00000X
Occupational Therapist
Primary
11061
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00354590
—
NY
Enumeration date
02/27/2017
Last updated
03/09/2019
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