Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 18506 | CA |
NPI | 1003311523 |
---|---|
Provider Name | Andrea Faugstad |
First Address | Orange, CA 92866-2048 |
Second Address | Orange, CA 92866-2048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2018 |
Last Update Date | 27/03/2018 |