Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 9590 | CA |
N | 225XF0002X | Feeding, Eating & Swallowing | 9590 | CA |
N | 225XG0600X | Occupational Therapist - Gerontology | 9590 | CA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 9590 | CA |
NPI | 1023353505 |
---|---|
Provider Name | Lisa Marnell |
First Address | Chatsworth, CA 91311 |
Second Address | Chatsworth, CA 91311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2012 |
Last Update Date | 10/12/2012 |