Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4045 | CA |
NPI | 1063949881 |
---|---|
Provider Name | Honor Galloway |
First Address | Lakewood, CA 90713-3115 |
Second Address | Downey, CA 90242-3456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 11/05/2017 |