Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand |
NPI | 1235727132 |
---|---|
Provider Name | Kim Vonk |
First Address | La Mesa, CA 91942-4140 |
Second Address | La Mesa, CA 91942-3806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2021 |
Last Update Date | 06/01/2021 |