Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT 13905 | CA |
NPI | 1124418538 |
---|---|
Provider Name | Joanne Lim |
First Address | San Mateo, CA 94401-2067 |
Second Address | Hayward, CA 94545-4339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2015 |
Last Update Date | 24/01/2015 |