Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 6665 | CA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 6665 | CA |
NPI | 1205159936 |
---|---|
Provider Name | Gina Banks |
First Address | Benicia, CA 94510-3559 |
Second Address | Benicia, CA 94510-3559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2010 |
Last Update Date | 09/03/2010 |