Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 11607 | CA |
NPI | 1003211178 |
---|---|
Provider Name | Barbara Leung |
First Address | Glendora, CA 91741-4327 |
Second Address | Los Angeles, CA 90033-5313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2014 |
Last Update Date | 30/10/2014 |