Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 2343 | CA |
NPI | 1568594539 |
---|---|
Provider Name | Liane Hewitt |
First Address | Grand Terrace, CA 92313-5216 |
Second Address | Loma Linda, CA 92350-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 08/07/2007 |