Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT16347 | CA |
NPI | 1003577024 |
---|---|
Provider Name | Celeste Marty |
First Address | San Francisco, CA 94122-1510 |
Second Address | San Francisco, CA 94112-4208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2022 |
Last Update Date | 02/01/2022 |