Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY28548 | CA |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1013319169 |
---|---|
Provider Name | Chelsea O'haire |
First Address | Atlanta, GA 30339-4265 |
Second Address | Los Angeles, CA 90027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2014 |
Last Update Date | 11/01/2017 |