Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT4513 | CA |
NPI | 1093710279 |
---|---|
Provider Name | Laurie Champagne Roundtree |
First Address | Thousand Oaks, CA 91360-5831 |
Second Address | Thousand Oaks, CA 91360-5831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 14/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4484430001 | DMERC (01) | CA |