Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 15396 | CA |
NPI | 1144685934 |
---|---|
Provider Name | Lonna Gorenflo |
First Address | Brimley, MI 49715-9261 |
Second Address | Dallas, TX 75234-1905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2015 |
Last Update Date | 21/12/2015 |