Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 3327 | CA |
NPI | 1003891698 |
---|---|
Provider Name | Mr. Mark Yamada |
First Address | Fair Oaks, CA 95628-3902 |
Second Address | Sacramento, CA 95817-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 08/07/2007 |