Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XF0002X | Feeding, Eating & Swallowing | OT 3698 | CA |
N | 225XM0800X | Mental Health | OT 3698 | CA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT 3698 | CA |
NPI | 1881096618 |
---|---|
Provider Name | Jennifer Canaris |
First Address | Chula Vista, CA 91915-2223 |
Second Address | Chula Vista, CA 91914-4526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2014 |
Last Update Date | 25/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT3698 | LICENSE (01) | CA |