Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 10122 | CA |
NPI | 1093103228 |
---|---|
Provider Name | Linda Pittman |
First Address | Long Beach, CA 90807-4422 |
Second Address | Long Beach, CA 90807-4422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2014 |
Last Update Date | 22/12/2014 |