Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 11043 | CA |
NPI | 1265889455 |
---|---|
Provider Name | Lorraine Makatu |
First Address | Northridge, CA 91325-3716 |
Second Address | Northridge, CA 91325-3716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2016 |
Last Update Date | 18/05/2016 |