Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT538 | CA |
N | 225XH1200X | Occupational Therapist - Hand | 9105000422 | CA |
NPI | 1144348749 |
---|---|
Provider Name | Marie Janet Damron |
First Address | Bakersfield, CA 93301 |
Second Address | Bakersfield, CA 93301-5026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 23/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ZZZ05291Z | MEDICARE INDIVIDUAL PTAN (01) | CA |
ZZZ21295Z | MEDICARE GROUP PTAN (01) | CA |