Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 12483 | CA |
NPI | 1013452119 |
---|---|
Provider Name | Jamie Lutat |
First Address | Vallejo, CA 94589-2226 |
Second Address | Vallejo, CA 94589-2226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2016 |
Last Update Date | 19/04/2017 |