Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 4664 | CA |
NPI | 1205167905 |
---|---|
Provider Name | Betsy Mccormick |
First Address | Fairfield, CA 94535-1809 |
Second Address | Fairfield, CA 94535-1809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2010 |
Last Update Date | 30/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4664 | OCCUPATIONAL THERAPIST (01) | CA |