Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 10063 | CA |
NPI | 1003230368 |
---|---|
Provider Name | Andrew Cole |
First Address | Los Angeles, CA 90038-3698 |
Second Address | Los Angeles, CA 90038-3698 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2014 |
Last Update Date | 06/02/2014 |