Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1730679531 |
---|---|
Provider Name | Lori Zack |
First Address | San Diego, CA 92117-1360 |
Second Address | San Diego, CA 92117-1360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2018 |
Last Update Date | 16/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT3225 | CALIFORNIA BOARD OF OCCUPATIONAL THERAPY (01) |