Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 13439 | CA |
NPI | 1003225681 |
---|---|
Provider Name | Breanna Canclini |
First Address | Cameron Park, CA 95682 |
Second Address | Cameron Park, CA 95682 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2014 |
Last Update Date | 07/08/2014 |