Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand |
NPI | 1104104363 |
---|---|
Provider Name | Minnie Mau |
First Address | Vacaville, CA 95688-2651 |
Second Address | Oakland, CA 94612-2920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2011 |
Last Update Date | 21/07/2011 |