Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 10154 | CA |
NPI | 1033445317 |
---|---|
Provider Name | Jill Davidson Mason |
First Address | Roseville, CA 95661-2931 |
Second Address | Roseville, CA 95661-2931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2009 |
Last Update Date | 06/12/2012 |