Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XF0002X | Feeding, Eating & Swallowing | 5468 | CA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5468 | CA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5468 | CA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 5468 | CA |
NPI | 1720354160 |
---|---|
Provider Name | Fiona Rea |
First Address | San Dimas, CA 91773-1209 |
Second Address | San Dimas, CA 91773-1209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2012 |
Last Update Date | 30/07/2020 |