Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OTA3844 | CA |
NPI | 1144728460 |
---|---|
Provider Name | Alicia Rochelle Hawley |
First Address | Davis, CA 95618-1551 |
Second Address | Vacaville, CA 95688-3635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2018 |
Last Update Date | 31/01/2021 |