Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 16430 | CA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT16430 | CA |
NPI | 1134601446 |
---|---|
Provider Name | Miss Wing Chi Chan |
First Address | San Francisco, CA 94134-1310 |
Second Address | San Francisco, CA 94115-2829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2018 |
Last Update Date | 04/09/2018 |