Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2317 | CA |
N | 225XE0001X | Environmental Modification | 2317 | CA |
NPI | 1336754498 |
---|---|
Provider Name | Jean Ihle |
First Address | Mill Valley, CA 94941-1551 |
Second Address | Mill Valley, CA 94941-1551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2020 |
Last Update Date | 14/09/2020 |