Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 15879 | CA |
NPI | 1003279720 |
---|---|
Provider Name | Ivonne Calle |
First Address | Walnut Creek, CA 94596-4717 |
Second Address | Kennett Square, PA 19348-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 30/03/2016 |