Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 7910 | CA |
NPI | 1629694161 |
---|---|
Provider Name | Gina Erdman |
First Address | Long Beach, CA 90815-3646 |
Second Address | Long Beach, CA 90815-3646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2020 |
Last Update Date | 21/06/2020 |