Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 11340 | CA |
NPI | 1003262163 |
---|---|
Provider Name | Karen Shelton |
First Address | Santa Ana, CA 92705 |
Second Address | Santa Ana, CA 92705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2016 |
Last Update Date | 09/05/2016 |