Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA3952 | CA |
NPI | 1023592433 |
---|---|
Provider Name | Marline Derilus |
First Address | Monterey, CA 93940-2042 |
Second Address | Monterey, CA 93940-2042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2018 |
Last Update Date | 20/09/2018 |