Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1879 | CA |
NPI | 1023423522 |
---|---|
Provider Name | Jennifer Miller |
First Address | Riverside, CA 92501-3400 |
Second Address | Riverside, CA 92501-3400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2014 |
Last Update Date | 24/06/2014 |