Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT17448 | CA |
NPI | 1023593811 |
---|---|
Provider Name | Chelsea Mcmillen |
First Address | Capitola, CA 95010-2103 |
Second Address | Capitola, CA 95010-2103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2018 |
Last Update Date | 27/09/2018 |