Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT 10886 | CA |
NPI | 1396187506 |
---|---|
Provider Name | Jaimee Criswell |
First Address | Escondido, CA 92027-4424 |
Second Address | San Diego, CA 92111-3742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2013 |
Last Update Date | 29/07/2013 |