Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XE0001X | Environmental Modification | OT 4438 | CA |
N | 2251E1200X | Ergonomics | OT 4438 | CA |
N | 225XE1200X | Ergonomics | OT 4438 | CA |
N | 225XL0004X | Low Vision | OT 4438 | CA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT 4438 | CA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT 4438 | CA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT 4438 | CA |
NPI | 1245541861 |
---|---|
Provider Name | Mr. Brad Charles Anderson |
First Address | Pasadena, CA 91104-2650 |
Second Address | Pasadena, CA 91104-2947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 29/06/2010 |