Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1751 | CA |
NPI | 1003947912 |
---|---|
Provider Name | Melissa Izzi |
First Address | El Dorado Hills, CA 95762-7502 |
Second Address | Placerville, CA 95667-4543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |