Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 002252 | IA |
N | 225XG0600X | Occupational Therapist - Gerontology | 056.009833 | IL |
Y | 225XG0600X | Occupational Therapist - Gerontology | OT 3149 | CA |
NPI | 1275993198 |
---|---|
Provider Name | Julie Rettberg |
First Address | Saratoga, CA 95070-5927 |
Second Address | Saratoga, CA 95070-5927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2016 |
Last Update Date | 04/03/2016 |