Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5543 | CA |
NPI | 1518413954 |
---|---|
Provider Name | Gina Tucker-Roghi |
First Address | Santa Rosa, CA 95409-2821 |
Second Address | Santa Rosa, CA 95409-2821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2016 |
Last Update Date | 26/08/2016 |