Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 8646 | CA |
NPI | 1003315169 |
---|---|
Provider Name | Kevin Mccarthy |
First Address | Sonoma, CA 95476 |
Second Address | Sonoma, CA 95476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2018 |
Last Update Date | 05/02/2018 |