Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 17844 | CA |
NPI | 1265944656 |
---|---|
Provider Name | Kristen Henderson |
First Address | Cotati, CA 94931-4167 |
Second Address | Vallejo, CA 94589-2441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2017 |
Last Update Date | 03/01/2022 |