Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 21962 | CA |
NPI | 1003407065 |
---|---|
Provider Name | Jessica Cornette |
First Address | Pasadena, CA 91106-2380 |
Second Address | Huntington Beach, CA 92649-1060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2021 |
Last Update Date | 01/02/2021 |