Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT 1052 | CA |
NPI | 1770973786 |
---|---|
Provider Name | John Mueggenburg |
First Address | Roseville, CA 95661-7329 |
Second Address | Roseville, CA 95661-7329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2015 |
Last Update Date | 28/01/2015 |