Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 3430 | CA |
NPI | 1023556180 |
---|---|
Provider Name | Lisa Ciotto |
First Address | Redondo Beach, CA 90277-2860 |
Second Address | Redondo Beach, CA 90277-2860 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2017 |
Last Update Date | 08/02/2017 |