Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 4480 | CA |
NPI | 1730582909 |
---|---|
Provider Name | Matthew Stahl |
First Address | Petaluma, CA 94954-8508 |
Second Address | Wilsonville, OR 97070-9697 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2014 |
Last Update Date | 02/10/2014 |