Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033432182 |
---|---|
Provider Name | Kristy Kierulff |
First Address | Fullerton, CA 92832-1321 |
Second Address | Fullerton, CA 92831-3839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2010 |
Last Update Date | 27/06/2014 |