Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 1189 OT | CA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 1189 OT | CA |
NPI | 1619190576 |
---|---|
Provider Name | Carla Jenkins-Skelton |
First Address | Riverside, CA 92506-5401 |
Second Address | Fontana, CA 92335-6720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |