Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 15831 | CA |
NPI | 1205873148 |
---|---|
Provider Name | Doris A Mesch |
First Address | Ventura, CA 93003-3101 |
Second Address | Simi Valley, CA 93065-2352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 25/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
056001745 | LICENSE (01) | IL |