Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT19613 | CA |
NPI | 1003468299 |
---|---|
Provider Name | Mr. Geordan Klein |
First Address | Murrieta, CA 92562-7079 |
Second Address | Murrieta, CA 92562-7079 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2019 |
Last Update Date | 09/07/2019 |