Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA2738 | CA |
NPI | 1003322850 |
---|---|
Provider Name | Kerri Lynn Connolly |
First Address | Napa, CA 94558-2603 |
Second Address | Napa, CA 94559-4824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2017 |
Last Update Date | 15/12/2017 |