Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT16740 | CA |
NPI | 1205214392 |
---|---|
Provider Name | Heather Gene Van Buren |
First Address | Ventura, CA 93003-5792 |
Second Address | Ventura, CA 93003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2015 |
Last Update Date | 08/12/2016 |