Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 12954 | CA |
N | 225XG0600X | Occupational Therapist - Gerontology | 12954 | CA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 12954 | CA |
NPI | 1316585557 |
---|---|
Provider Name | Mr. Max Paul Zweig |
First Address | Santa Rosa, CA 95405-7619 |
Second Address | Santa Rosa, CA 95405-7619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2019 |
Last Update Date | 18/12/2019 |