Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 20636 | CA |
NPI | 1003573486 |
---|---|
Provider Name | Mr. Casey Cho |
First Address | Hayward, CA 94544-6663 |
Second Address | San Leandro, CA 94579-1972 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2021 |
Last Update Date | 20/11/2021 |