Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT30161 | CA |
N | 2251E1200X | Ergonomics | OT30161 | CA |
N | 225XE1200X | Ergonomics | OT30161 | CA |
N | 225XH1200X | Occupational Therapist - Hand | OT30161 | CA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT30161 | CA |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT30161 | CA |
NPI | 1396887279 |
---|---|
Provider Name | Ellen Obenberger |
First Address | Mammoth Lakes, CA 93546-0660 |
Second Address | Mammoth Hospital, CA 93546-0660 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |