Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1341 | CA |
NPI | 1013221365 |
---|---|
Provider Name | Laura Jean Hogan-Reyes |
First Address | Pasadena, CA 91105-2544 |
Second Address | Pasadena, CA 91105-2544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2010 |
Last Update Date | 28/07/2010 |