Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT6273 | CA |
NPI | 1043304520 |
---|---|
Provider Name | Karen Crouch |
First Address | Costa Mesa, CA 92626 |
Second Address | Costa Mesa, CA 92626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A007 | TRICARE (01) | CA |
OT0062730 | BLUE SHIELD (01) | CA |