Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
N | 225X00000X | Occupational Therapist | OT-1656 | ID |
Y | 225X00000X | Occupational Therapist | OT16845 | CA |
N | 225XM0800X | Mental Health | OT16845 | CA |
NPI | 1184166316 |
---|---|
Provider Name | Elise Blanton-Hubbard |
First Address | Berkeley, CA 94703-1108 |
Second Address | Berkeley, CA 94703-1108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2016 |
Last Update Date | 30/09/2021 |