Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 17916 | CA |
NPI | 1003317926 |
---|---|
Provider Name | Amy Ahn |
First Address | Orange, CA 92868-3808 |
Second Address | Fountain Valley, CA 92708-2836 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2018 |
Last Update Date | 26/02/2018 |