Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 4523 | CA |
NPI | 1003475245 |
---|---|
Provider Name | Kimberly Easton |
First Address | Santa Monica, CA 90403-2974 |
Second Address | Santa Monica, CA 90403-2974 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2019 |
Last Update Date | 11/06/2019 |