Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XF0002X | Feeding, Eating & Swallowing | OT1109 | CA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT 1109 | CA |
NPI | 1083942148 |
---|---|
Provider Name | Mary Ellen Florendo-Tan |
First Address | West Covina, CA 91792-1214 |
Second Address | Claremont, CA 91711-5204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2009 |
Last Update Date | 01/12/2009 |