Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 16246 | CA |
NPI | 1003284563 |
---|---|
Provider Name | Jessica A Doran |
First Address | Torrance, CA 90502-4418 |
Second Address | Santee, CA 92071-4516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2015 |
Last Update Date | 12/11/2018 |