Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT9650 | CA |
N | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1689133100 |
---|---|
Provider Name | Danielle Marie Jette-Lee |
First Address | Fountain Valley, CA 92708-5514 |
Second Address | Laguna Hills, CA 92637-3883 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2019 |
Last Update Date | 14/03/2019 |