Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 19394 | CA |
NPI | 1184210106 |
---|---|
Provider Name | Kelsey Amanda Quinlan |
First Address | San Diego, CA 92111-3744 |
Second Address | San Diego, CA 92111-3744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2020 |
Last Update Date | 14/12/2020 |