Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 1311 | CA |
NPI | 1457478760 |
---|---|
Provider Name | Marijane Miyake |
First Address | Rancho Palos Verdes, CA 90275-2370 |
Second Address | Rancho Palos Verdes, CA 90275-2370 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |