Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 22280 | CA |
NPI | 1073196804 |
---|---|
Provider Name | Bethany Kimi Kalani Tomokiyo |
First Address | Anaheim, CA 92808-2283 |
Second Address | Anaheim, CA 92808-2283 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2021 |
Last Update Date | 09/12/2021 |