Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT14510 | CA |
NPI | 1396233128 |
---|---|
Provider Name | Charlene Yun |
First Address | Henderson, NV 89052-3871 |
Second Address | Henderson, NV 89052-3871 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2018 |
Last Update Date | 30/06/2020 |