Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 15561 | CA |
NPI | 1053774281 |
---|---|
Provider Name | Michael Dreyfuss |
First Address | Orange, CA 92869-5818 |
Second Address | Orange, CA 92869-5818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2016 |
Last Update Date | 04/04/2016 |