Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 20247 | CA |
NPI | 1811564180 |
---|---|
Provider Name | Cody Lutz |
First Address | Livermore, CA 94551-0716 |
Second Address | Monterey, CA 93940-5902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2021 |
Last Update Date | 07/06/2021 |