Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT1062 | CA |
NPI | 1114414323 |
---|---|
Provider Name | Mr. Martinus Jansen |
First Address | Redlands, CA 92373-5783 |
Second Address | Redlands, CA 92373-5783 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2018 |
Last Update Date | 13/04/2018 |