Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 920 | CA |
NPI | 1003118407 |
---|---|
Provider Name | Gay Mantey |
First Address | Laguna Hills, CA 92653-5332 |
Second Address | Laguna Hills, CA 92653-5332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2010 |
Last Update Date | 17/11/2010 |