Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT16411 | CA |
NPI | 1023563079 |
---|---|
Provider Name | Danielle Carbaugh |
First Address | San Diego, CA 92128-2413 |
Second Address | San Diego, CA 92128-2413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2016 |
Last Update Date | 19/08/2016 |