Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 560458 | CA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 560458 | CA |
NPI | 1073888913 |
---|---|
Provider Name | Julie Ellen Papadakis |
First Address | Lake Forest, CA 92630-1645 |
Second Address | Lake Forest, CA 92630-1645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2012 |
Last Update Date | 10/03/2012 |