Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT4211 | CA |
NPI | 1023119005 |
---|---|
Provider Name | Mary Louise Dahl |
First Address | Cameron Park, CA 95682 |
Second Address | Placerville, CA 95667 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |