Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | 00978 | CA |
N | 225400000X | Rehabilitation Practitioner | 00978 | CA |
Y | 225X00000X | Occupational Therapist | 00978 | CA |
N | 2251E1200X | Ergonomics | OT00978 | CA |
N | 225XE1200X | Ergonomics | OT00978 | CA |
N | 225XH1200X | Occupational Therapist - Hand | 00978 | CA |
N | 2251H1300X | Human Factors | 00978 | CA |
N | 225XH1300X | Human Factors | 00978 | CA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 00978 | CA |
N | 225XP0200X | Occupational Therapist - Pediatrics | 00978 | CA |
N | 225XR0403X | Driving and Community Mobility | 00978 | CA |
NPI | 1316925282 |
---|---|
Provider Name | Mr. Manuel Bouffard |
First Address | Long Beach, CA 90807-3717 |
Second Address | Long Beach, CA 90807-2374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2006 |
Last Update Date | 16/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5208580001 | DMERC (01) | CA |
ZZZ08589Z | BLUE SHIELD OF CALIFORNIA (01) | CA |