Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 14101 | CA |
NPI | 1003340118 |
---|---|
Provider Name | Jennifer Tang |
First Address | Culver City, CA 90232-6818 |
Second Address | Culver City, CA 90232-6818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2017 |
Last Update Date | 29/05/2020 |