Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4107 | CA |
NPI | 1265789515 |
---|---|
Provider Name | Judy Carney |
First Address | Lafayette, CA 94549-5546 |
Second Address | Lafayette, CA 94549-5546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2012 |
Last Update Date | 06/08/2012 |