Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 16419 | CA |
NPI | 1306394838 |
---|---|
Provider Name | Ashley Micks |
First Address | Palos Verdes Estates, CA 90274-1109 |
Second Address | Palos Verdes Estates, CA 90274-1109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2016 |
Last Update Date | 26/10/2019 |