Individual
FAJR GUY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
11027 174TH ST, JAMAICA, NY 11433-3521
(917) 847-3601
Mailing address
11027 174TH ST, JAMAICA, NY 11433-3521
(917) 847-3601
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0124721
NY
Other
Enumeration date
07/29/2019
Last updated
07/29/2019
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