Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT8896 | CA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT8896 | CA |
NPI | 1235257817 |
---|---|
Provider Name | Annette Hatala |
First Address | Huntington Beach, CA 92647-5495 |
Second Address | Huntington Beach, CA 92647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 27/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT8896 | LICENSE (01) | CA |