Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT5064 | CA |
NPI | 1093044034 |
---|---|
Provider Name | Karen D Pitbladdo |
First Address | San Francisco, CA 94118-3057 |
Second Address | San Francisco, CA 94118-3057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2009 |
Last Update Date | 22/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT5064 | LICENSE (01) | CA |