Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 4348 | CA |
NPI | 1720644263 |
---|---|
Provider Name | Laurene Elizabeth Fitzpatrick |
First Address | Fair Oaks, CA 95628-5803 |
Second Address | Carmichael, CA 95608-2933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2019 |
Last Update Date | 09/05/2019 |