Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | ||
Y | 225XP0200X | Occupational Therapist - Pediatrics | 12038 | CA |
NPI | 1326438219 |
---|---|
Provider Name | Kelsey Bannan |
First Address | Ventura, CA 93003-6481 |
Second Address | Ventura, CA 93003-6481 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2015 |
Last Update Date | 29/01/2015 |