Individual
VITA BOSCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
345 RESERVOIR RD, GOSHEN, NY 10924-5706
(845) 544-3785
Mailing address
345 RESERVOIR RD, GOSHEN, NY 10924-5706
(845) 544-3785
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
008562-1
NY
Other
Enumeration date
10/17/2014
Last updated
10/17/2014
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