Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT 8552 | CA |
N | 225XG0600X | Occupational Therapist - Gerontology | ||
N | 225XM0800X | Mental Health | ||
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | ||
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1043637986 |
---|---|
Provider Name | Dax Ganzon |
First Address | Elk Grove, CA 95758-1321 |
Second Address | Elk Grove, CA 95758-1321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2014 |
Last Update Date | 27/03/2014 |